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Biomedical subjects

M Salavert

Publications and source records attributed to M Salavert.

At least 19 recordsLinked to original sources
PubMed2006

[Erosive pustular dermatosis of the leg: role of zinc deficiency?].

BACKGROUND: Erosive pustular dermatosis of the legs is a rare and recently described condition seen in elderly subjects. It is characterised by symmetric erosions of the legs resulting from a confluence of sterile pustules, usually following minor trauma. Treatment with dermal corticosteroids is rapidly effective but is not codified and relapse is common. CASE-REPORTS: Three patients aged respectively 74, 84 and 92 years presented ulcers of the legs and ankles associated with peripheral pustules following minor injury. These pustules were sterile and exhibited a spongiform appearance on histological examination. None of these patients had a prior history of psoriasis. However, all presented zinc deficiency. Treatment with dermal corticosteroids combined with oral zinc gluconate resulted in complete resolution in two of the patients after several days of therapy and proved effective during relapse in the third patient. DISCUSSION: Erosive pustular dermatosis of the legs is a benign dermatosis that is probably under-reported that should be included in the category of inflammatory neutrophilic dermatoses. The cases we present suggest a triggering or enhancing role of zinc deficiency.

Adrenal Cortex Hormones↗
PubMed2006

[Individualized evaluation of the risk of infections in the oncohematologic patient].

In order to take the best approach to infection in the oncohematologic patient with fever, it is important to know not only how profound the neutropenia is and how long the patient has had it, but also the characteristics of the underlying disease, the immunosuppressive therapy received and the type of hematopoietic stem/progenitor cell transplantation performed. Moreover, is important to consider if these patients have any personal or familial history of infectious diseases. All these aspects let us calculate the net state of immunosuppression and the risk of infection, and provide us with information about the most probable etiology in each case and the best prophylaxis and treatment. In this study we review the more important advances in chemotherapy in recent years that will make it necessary in the future to change our prophylactic guidelines for more effective prevention of infection in the oncohematologic patient.

Fever↗
PubMed2006

[Cefditoren pivoxil: A new oral cephalosporin for skin, soft tissue and respiratory tract infections].

Cefditoren pivoxil, a new-third generation cephalosporin antibiotic that has recently been granted approval in Spain, shows important activity over a large part of the pathogens causing skin, soft tissue and respiratory tract infections, including Gram-negative and Gram-positive bacteria. Cefditoren has also been shown to be stable against hydrolysis by many common beta-lactamases. Data from in vitro studies and clinical trials show this antibiotic as an oral formulation with an intrinsic activity against Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae equivalent to that of other third-generation cephalosporins administered via parenteral, like cefotaxime or ceftriaxone, thereby placing its maximal benefits mainly in the treatment of ambulatory infections. This paper reviews the main characteristics of cefditoren pivoxil (spectrum of activity, chemical structure, mechanism of action, pharmacokinetics, adverse effects and clinical efficacy) and attempts to find its place in current antibiotic therapeutics.

Administration, Oral↗
PubMed2005

Aspergillus infections in lung transplant recipients: risk factors and outcome.

This retrospective study of 251 lung transplant patients aimed to determine the prevalence, clinical presentation and mortality of Aspergillus infection in order to define specific risk factors and to compare survival in patients with and without infection. Aspergillus was isolated from 86 (33%) cases, which involved colonisation (n = 50), tracheobronchial lesions (n = 17) or invasive aspergillosis (n = 19). Overall, aspergillosis had an impact on survival (p < 0.05); in fact the 5-year mortality rate was substantially higher in single lung transplant recipients with bronchial anastomotic infection, and in those with late-onset infections and chronic rejection. A significant association (p < 0.05) was found between acute rejection and the time at which fungal infection was diagnosed. Aspergillus infection was not related to cytomegalovirus infection or treatment with corticosteroids. The mortality rate for invasive infections was 78% and was related to survival (p < 0.0001); invasive aspergillosis was also associated with chronic rejection (p < 0.05), but not with high corticosteroid doses (p 0.49) or use of tacrolimus (p 0.73). In conclusion, Aspergillus infection was associated with a reduction in the 5-year survival rate of lung transplant recipients, and this was particularly true for patients infected with the invasive forms and for patients with single lung transplants, bronchial anastomotic infection and chronic rejection. Isolation of Aspergillus spp. from respiratory samples preceded acute rejection, and may be a marker of graft dysfunction and/or airway inflammation. Close monitoring, or even pre-emptive antifungal therapy, is recommended for patients with chronic rejection or bronchial airway mechanical abnormalities and persistent Aspergillus colonisation.

Aspergillosis↗
PubMed2003

Visceral leishmaniasis in lung transplantation.

Infection by intracellular microorganisms with a special geographic distribution, such as Leishmania spp, has been reported in a limited number of patients undergoing solid-organ transplant (SOT). No cases of Leishmania spp infection in lung transplant patients were found in a review of the literature. In our series of 222 lung or heart and lung transplantations performed from February 1990 to October 2002, two cases of visceral leishmaniasis (VL) were diagnosed and treated with liposomal amphotericin B. All cases reported to date in transplant patients, including the ones discussed here, occurred in people living in or traveling to countries in the Mediterranean area. We therefore consider it advisable to include serological testing for latent infection due to Leishmania spp in pretransplantation screening for our geographical setting, despite the limited return of this strategy.

Adult↗
PubMed2002

Two cases of fungemia due to Candida lusitaniae and a literature review.

Reported here are two cases of candidemia caused by Candida lusitaniae that occurred in two immunocompromised patients at Hospital Universitario "La Fe" in Valencia, Spain. Case 1 involved a low-birth-weight premature infant with congenital nephrotic syndrome who was successfully treated with amphotericin B, and case 2 involved a 50-year old woman with a high-grade malignancy lymphoma who succumbed to the infection. Antifungal susceptibility testing of the Candida lusitaniae isolates recovered from both patients revealed sensitivity to amphotericin, 5-flucytosine and fluconazole. Results are presented and discussed together with a comprehensive review of the literature, covering all previously reported cases of fungemia caused by this emerging pathogen.

Amphotericin B↗
PubMed2002

Early infections in adult patients undergoing unrelated donor cord blood transplantation.

Early transplant-related mortality after cord blood transplantation from unrelated donors (UD-CBT) is close to 50%, mainly due to infectious complications. We have studied the incidence and characteristics of early infections (before day 100) in a series of 27 adult patients (median age 30 years, range 16-46) undergoing UD-CBT at a single institution. All 27 patients experienced at least one infectious episode and 18 (66%) suffered a severe infection. Bacteremia occurred in 55% of patients (13 with Gram-positive and 11 with Gram-negative microorganisms). Eleven of 19 CMV-seropositive patients (58%) developed CMV antigenemia and one patient had CMV disease. Fungal infections were documented in three patients (11%), comprising invasive fungal infections in two cases and a localized esophagitis in one. Ten patients (37%) died before day 100 after transplantation. Infection was considered the primary cause of death in four patients (sepsis by Acinetobacter spp. bacteremia in three cases) and contributed to death in another four. The most striking findings in this series were the high incidence of, and mortality due to multiresistant Acinetobacter spp. and the low incidence of and lack of mortality due to CMV disease. This report confirms that infection is a major complication in adults undergoing UD-CBT.

Acinetobacter Infections↗
PubMed2000

[Fournier's gangrene. A study of 12 patients and a review].

We present the clinicoepidemiological and therapeutic characteristics of 12 patients with Fournier's gangrene. The mean age of the patients was 66 years and all had a known predisposing factor for the disease. In all cases there was a predominance of mixed flora (four Gram-positive cocci, nine Gram-negative bacilli and ten anaerobic pathogens), with only one case of bacteremia reported. Initial surgery was conducted and was complemented by antimicrobial administration (imipenem, cefotaxime, clindamycin, penicillin and gentamicin alone and in combination) and local treatment with sugar and povidone-iodine. Hyperbaric oxygen was not used in any cases. At the end of treatment a mesh graft could be applied in 11 patients, all of whom showed an excellent functional and aesthetic recovery. The mean time of hospital stay was lengthy (49 days). The good evolution of the lesions after starting the local treatments with the sugar povidone-iodine combination should be emphasized.

Administration, Topical↗
PubMed2000

[Subacute endocarditis caused by Actinobacillus actinomycetemcomitans].

BACKGROUND: We describe the cases of endocarditis caused by Actinobacillus actinomycetemcomitans (EAA) observed at our hospital. PATIENTS AND METHODS: We revised clinical records and microbiological documents from patients admitted at our hospital, with A. actinomycetemcomitans in blood cultures occurred from 1972-1998. We used Dukes's diagnostic criterion of infectious endocarditis. RESULTS: Four patients were diagnosed of EAA for twelve years, there were males and two females. Two cases have had valvular prosthesis and three patients suffered a previous odontological manipulation. All cases were clinical subacute presentation. Two patients have had at a distance endocarditis clinical manifestation (neurological deficit and Osler nodules). All patients were febrile and elevation of acute reactants, two cases had inflammatory anemia and one had cardiac failure. We observed growing signs after 7 days of culture and it was necessary, on solid medium, adequate atmosphere and nutritional composition to procure A. actinomycetemcomitans growing. All isolates were susceptible to studied penicillins or aminopenicillins (except one isolate with intermediate susceptibility), aminoglycosides and quinolones. Treatment with penicillin G, lone or combined with aminoglycosides, controlled infection in three patients. No case needed cardiac surgery. CONCLUSIONS: In our experience, EAA is a strange entity and there isn't a previous cardiac disease always. Usually, the place of entrance is a buccal focus. Subacute-chronic course and, sometimes, uncommon, can delay diagnostic during months. Our isolates have an uniform sensibility to penicillins and others betalactamic, anyway aminoglycosides and quinolones, therefore an antibiotic combination of two antibiotics from these families at least could be the choice treatment. Except evolutive complications in some patient, prognostic has been excellent with only antibiotic treatment, without valvular surgery.

Actinobacillus Infections↗
PubMed1999

Value of the polymerase chain reaction assay in noninvasive respiratory samples for diagnosis of community-acquired pneumonia.

We studied the causes of community-acquired pneumonia (CAP) in 184 patients. Microbiologic evaluation included sputum examination, blood culture, assessment of acute and convalescent antibody titers for Legionella pneumophila, Mycoplasma pneumoniae, Chlamydia pneumoniae, Coxiella psitacci, Coxiella burnetii and respiratory viruses, polymerase chain reaction (PCR) assays for M. pneumoniae and C. pneumoniae in throat swab, and PCR assay based on the amplification of pneumolysin gene fragment in sera. The causative pathogen was identified in 78 patients (Streptococcus pneumoniae, 44; M. pneumoniae, 26; C. pneumoniae, 1; others, 7). S. pneumoniae was detected in serum by the PCR assay in 41 patients, five of whom also had a positive blood culture. PCR assay was negative in two patients with positive blood culture for S. pneumoniae. C. pneumoniae was detected by PCR in nine patients, but only one showed seroconversion. M. pneumoniae was detected by PCR in only three patients (two without seroconversion). The diagnosis of pneumonia caused by S. pneumoniae was five times greater using PCR in serum than with blood culture. Detection of C. pneumoniae by PCR without fulfilling criteria for acute infection may be considered a prior infection. The PCR assay for the diagnosis of M. pneumoniae has a lower sensitivity than serologic methods.

Adolescent↗
PubMed1998

Thoracic infection caused by Streptococcus milleri.

The objective of this study was to increase our understanding of the importance of members of the Streptococcus milleri (SM) group as respiratory pathogens, by studying the epidemiological and clinical features of thoracic infections caused by this group and comparing the epidemiology and prognosis of empyema caused by SM with cases of pneumococcal aetiology. The clinical histories and microbiology reports were reviewed in 27 cases of thoracic infection caused by SM over a period of 8 yrs. Cases of pneumococcal empyema that occurred during the same period were also analysed. Diagnoses were made of cases of empyema, including six with pneumonia and one with pulmonary abscess, three cases of pneumonia and two of mediastinitis. In 17 cases, SM was the only pathogen isolated. There was a history of instrument or surgical procedures on the digestive or respiratory tract in 59%. Secondary bacteraemia was documented in three cases. The treatment administered, a combination of antibiotics and surgery, was successful in 22 of 27 (81%) of cases. All strains were susceptible to penicillin. When the characteristics of the empyemas caused by monomicrobial SM infection were compared with those of pneumococcal aetiology from the same period of study, significant differences were found with respect to age, origin of the infection and the need for surgery. In conclusion, thoracic infections caused by Streptococcus milleri are largely pleural. They are polymicrobial in one-third of cases, commonly acquired in hospital and, in most patients, associated with major surgery and/or surgical procedures of the respiratory or digestive tract. The empyema frequently requires thoracotomy for complete resolution.

Anti-Bacterial Agents↗