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Biomedical subjects

M L Fernández-Guerrero

Publications and source records attributed to M L Fernández-Guerrero.

At least 19 recordsLinked to original sources
PubMed2006

The role of splenectomy in HIV-infected patients with relapsing visceral leishmaniasis.

The treatment of visceral leishmaniasis (VL) in HIV-infected patients is characterized by having a protracted course and frequent relapses, despite the use of adequate anti-leishmanial drugs and effective anti-retroviral therapy. A small subset of patients with significant splenomegaly develops severe cytopaenias and chronic leishmania infection. The use of elective splenectomy is effective for restoring the haematological parameters and reduces the need for blood transfusions but it does not avoid relapsing visceral leishmaniasis.

AIDS-Related Opportunistic Infections↗
PubMed2002

Nosocomial enterococcal endocarditis: a serious hazard for hospitalized patients with enterococcal bacteraemia.

OBJECTIVES: Enterococci are a major leading cause of infectious endocarditis and also a common cause of hospital-acquired bacteraemia, which is not believed to represent a serious hazard for the endocarditis. The incidence and risk factors for infectious endocarditis in patients with hospital-acquired enterococcal bacteraemia is determined. METHODS: Prospective analysis of 116 patients with enterococcal bacteraemia admitted to medical or surgical wards of a tertiary-care, university affiliated hospital during a period of 5 years. Echocardiography was performed when indicated by clinical criteria. RESULTS: Seventy-five (61.4%) episodes were hospital-acquired and 47 (38.5%) were community-acquired. Most patients had one or more underlying chronic diseases and major abdominal (58.6%) or genitourinary (38.6%) surgery. Seventeen patients (14.6%) developed enterococcal endocarditis. By univariate analysis the risk factors associated with endocarditis were community-acquired infection (P 0.012); monomicrobial bacteraemia (P 0.006); three or more positive blood cultures (P < 0.001); underlying valvulopathy (P < 0.001); presence of a prosthetic valve (P < 0.001) and age (P 0.012). Six patients (8%) developed nosocomial endocarditis. In this group of patients, three or more positive blood cultures (P < 0.01), bacteraemia as a result of Enterococcus faecalis (P 0.007); underlying valvulopathy (P < 0.001) and presence of a prosthetic valve (P < 0.001) were associated with endocarditis. By logistic regression, the presence of underlying valvulopathy and three or more positive blood cultures were associated with endocarditis (OR 21.0; CI 95% 1.65-26.9; P 0.019). CONCLUSIONS: The risk of developing infectious endocarditis in patients with hospital-acquired enterococcal bacteraemia is significant. Patients with underlying valvulopathy and three or more positive blood cultures with E. faecalis are prone to nosocomial enterococcal endocarditis.

Adult↗
PubMed1995

Hospital-acquired infectious endocarditis not associated with cardiac surgery: an emerging problem.

To assess the most relevant features of hospital-acquired endocarditis, we conducted a retrospective study of cases of infectious endocarditis at a single university hospital from 1978 through 1992. During this period 248 episodes of infectious endocarditis were documented; 23 (9.3%) of these episodes were hospital-acquired and were not associated with cardiac surgery. (This figure represented a remarkable rise in the frequency of nosocomial endocarditis, only one case of which was identified among 101 cases of endocarditis treated at the same institution between 1960 and 1975.) In each of the 23 nosocomial cases, endocarditis was the result of bacteremia associated with a hospital-based procedure: intravenous catheterization (15 cases), instrumentation of a diseased urogenital tract (seven cases), or liver biopsy (one case). Staphylococcus aureus and Enterococcus faecalis were the predominant organisms isolated from intravenous catheters and the urogenital tract, respectively. Two of seven enterococcal isolates were highly resistant to gentamicin (MIC, > 2,000 micrograms/mL). Overall mortality was 56%. Two subsets of at-risk patients with different anatomic and clinical manifestations were identified. Our results emphasize that infectious endocarditis must be considered a serious nosocomial hazard against which preventive measures must be implemented.

Bacteremia↗
PubMed1995

[Bacteremia caused by group A and B beta-hemolytic Streptococcus in adults].

In order to know the epidemiological, clinical and evolutive characteristics of bacteriemia caused by beta-hemolytic streptococci groups A and B, a retrospective investigation was undertaken of 48 bacteremic episodes observed in adult patients for 10 years (1985-1994). Twenty-two episodes were caused by Group A beta-hemolytic streptococci (GAS) and 26 by Group B beta-hemolytic streptococci (GBS). Patients with GAS bacteremia (GASB) had a lower mean age than patients with GBS bacteremia (GBSB) (p = 0.03). Infection with immunodeficiency virus was more common in patients with GASB than in patients with GBSBA (27 and 4%, respectively; p = 0.04); in contrast, diabetes mellitus was more common in patients with GBSB than in patients with GASB (27 and 5%, respectively) (p = 0.04). Nine (41%) patients with GBSB were i.v. drug abusers; nevertheless, none of the subjects with GBSB were i.v. drug abusers (p < 0.001). The proportion of bacteremia without demonstrable source due to GBS (41%) was significantly higher than that due to GAS (9%) (p = 0.02). Five (23%) patients with GASB and other five (20%) patients with GBSB had fatal outcomes, but only in two (9%) and three (12%) cases, respectively, was death directly attributed to bacteremia. In conclusion, bacteremias caused by GAS and GBS have different epidemiological characteristics but similar prognosis.

Adult↗
PubMed1995

[Agrobacterium radiobacter bacteremia. Study of 2 cases and review of the literature].

BACKGROUND: Agrobacteria are small gramnegative bacilli which produce tumors in different vegetal species and occasionally are human pathogens. METHODS: A retrospective review was carried out and the contribution of 2 cases of bacteremia by Agrobacterium radiobacter reported. RESULTS: Both patients developed uncomplicated bacteremia easily controlled by antimicrobian treatment without requiring removal of the intravascular device in one. CONCLUSIONS: Agrobacterium is a rare cause of bacteremic infection in immunosuppressed patients with intravenous catheters. Although the isolations are sensitive to different antibiotics some strains present resistance to cefalosporines, aminoglycosides and cloramphenicol. The mortality of these infections is slight.

Adolescent↗
PubMed1995

[Tuberculous meningitis: prognostic aspects of 22 microbiologically confirmed cases].

BACKGROUND: Tuberculous meningitis continues to be a severe disease difficult to diagnose within a reasonable time carrying a high morbimortality. METHODS: A retrospective review of cases of microbiologically confirmed tuberculous meningitis diagnosed and treated in the authors' institution is presented. RESULTS: From 1974-1993, 22 patients (12 males and 10 females, mean age of 31.5 years; range: 4 months and 77 years) were studied. Eighteen patients (81%) presented extrameningeal tuberculosis. Seven (31.8%) died and 6 (27.3%) presented severe neurologic sequelae. The worst prognosis was observed in patients older than the mean (p = 0.03), worse neurologic situation on admittance (p = 0.03) and hydrocephaly diagnosed by imaging techniques (p = 0.04). Corticoids were administered in 15 patients (68%) without contributing comparatively to better disease prognosis. CONCLUSIONS: The authors consider that the initiation of specific early treatment in justified while awaiting microbiologic confirmation of the disease.

Adolescent↗
PubMed1994

[The clinical spectrum of focal infection due to nontyphoid Salmonella: 32 years' experience].

BACKGROUND: The aim of this study was to analyze the manifestations of the syndromes which constitute focal infection by Salmonella no typhi (SNT). METHODS: Ninety-one episodes of SNT infections studied over a period of 32 years in the Fundación Jiménez Díaz (Madrid, Spain) were retrospectively analyzed. RESULTS: Of the 1,892 patients with SNT infection studied during this period, 91 (5%) presented some focal form (57 males and 34 females) with a mean age of 49 years (SD +/- 21.6 years). Sixty percent of the episodes were acquired within the community. The localization of the focal infections by SNT was as follows: urologic tract (24%), intraabdominal (20%), soft tissues (16%), respiratory tract (15%), osteoarticular (14%), cardiovascular (10%) and central nervous system (1%). On comparison with the remaining patients, those with urinary, osteoarticular and respiratory infections were found to be the most frequently immunosuppressed (47%) vs 18%, p < 0.01) with a greater frequency of unfavorable evolution (57% vs 15%; p < 0.001). Mortality ranged between 7% for the osteoarticular forms to 64% for the pleuropulmonary forms of infection. CONCLUSIONS: Focal infection by Salmonella no typhi may be localized in any organ usually occurring in immunosuppressed patients or those with predisposing local factors. The osteoarticular, pulmonary, and urologic infections have a particularly unfavorable course and their presence may suggest the existence of immunosuppression.

Adolescent↗
PubMed1994

Development of myelopathy before herpes zoster rash in a patient with AIDS.

We describe the case of a patient with AIDS who developed progressive myelopathy due to varicella-zoster virus 2 months before the appearance of skin lesions typical of herpes zoster. Varicella-zoster virus was isolated from his CSF. Therapy with acyclovir failed to control his neurological complications despite its in vitro efficacy against the isolates.

AIDS-Related Opportunistic Infections↗
PubMed1993

[Endocarditis due to penicillin-sensitive and -resistant pneumococci: the current perspectives on the disease].

BACKGROUND: To evaluate the clinic characteristics and therapeutic aspects of endocarditis by Streptococcus pneumoniae sensitive and resistant to penicillin. METHODS: Twelve cases of pneumococcal endocarditis evaluated in 4 Spanish hospitals over the last 10 years were studied, analyzing their clinical characteristics and the existence of resistance to penicillin. The features were compared with a series of 98 cases found in a review of the literature. RESULTS: All the patients were males, most being alcoholics. The course of the disease was acute (2 weeks) in all the cases and evolved with great aggressivity: cardiac failure (9 patients), myocardial abscess (7 patients), multiple arterial embolisms (5 patients), septic arthritis (4 patients). Three patients had simultaneous pneumococcal meningitis but only one had pneumonia. The valve most affected was the aortic (9 cases). Three cases were due to strains of Streptococcus pneumoniae with moderate resistance to penicillin (CMI 0.5-1 micrograms/ml). Global mortality was 42%. All the patients receiving inadequate antibiotic treatment died. Vancomycin and cefotaxime appear to be effective in the treatment of cases produced by strains of pneumococcus with intermediate sensitivity to penicillin. There were no apparent differences in mortality between the cases of endocarditis by pneumococcus sensitive or moderately resistant to penicillin. CONCLUSIONS: Pneumococcal endocarditis continues to condition a high mortality similar to that produced in previously made series. The classic relation with meningitis and pneumonia is infrequent today. The appearance of strains resistant to penicillin may increase the incidence of this infection and further worsen prognosis.

Adult↗
PubMed1993

Zoonotic endocarditis.

The so-called zoonotic endocarditis is transmitted from animals to humans and is frequently found in some cattle-raising countries. Brucella endocarditis is a destructive process of the aortic valve with abscess formation that commonly leads to heart failure. Q fever endocarditis is a more indolent infection, but it is also capable of producing severe valvular damage and hemodynamic compromise. Treatment of zoonotic endocarditis includes the prolonged administration of doxycycline in combination with other antimicrobial agents and a judicious use of valve replacement. Mortality of Brucella endocarditis has been decreased significantly by a medical-surgical approach to treatment. On the basis of serologic and valve tissue culture results, no treatment is consistently able to cure Q fever endocarditis, and thus mortality of this infection remains high.

Animals↗
PubMed1992

[Mycobacteriosis during 1980-1990 in a Madrid hospital].

BACKGROUND: To assess the incidence and features of environmental mycobacteria that can produce disease over a ten years period (1980-1990) in an University Hospital from Madrid (Spain). METHODS: Medical records of all patients in whom and environmental mycobacteria that can produce disease had been isolated were reviewed and classified as definite, possible or not clinically significant isolates, according to clinical features and microbiologic findings. RESULTS: Mycobacterium species were isolated in 415 patients (491 clinical samples over a total of 3003, 16.3%). In 29 patients a environmental mycobacteria that can produce disease was identified. Medical records from 25 patients were retrieved, being this mycobacteria isolated classified as with definite clinical significance in 8 cases, with possible clinical significance in 4, and without clinical significance in 13 cases. Clinical features in the significant cases were: lung infection (3 cases), pleural and pericardial disease (1 case), peritonitis (1) and soft tissue infection (1) Two patients died. Surgical excision of the lesion was performed in the remaining patients, and clinical cure was achieved in five cases. CONCLUSIONS: The most prevalent mycobacterial infection in our environment is still due to M. tuberculosis infection, followed by M.avium-intracellulare. Surgical treatment is a valid approach in patients with localized infection by environmental mycobacteria that can produce diseases.

Adult↗
PubMed1988

Aortic endocarditis caused by gentamicin-resistant Enterococcus faecalis.

A case is reported of a patient who developed aortic endocarditis after protracted hospitalization during which time the patient received multiple courses of aminoglycoside and cephalosporin therapy. The infecting organism, an Enterococcus faecalis strain, was resistant to gentamicin and to the combination of ampicillin with gentamicin. Valve replacement was performed after four weeks of therapy with ampicillin, and enterococci were isolated from cardiac vegetations. Valve replacement may be necessary to achieve cure of endocarditis due to enterococci highly resistant to gentamicin.

Aged↗