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Biomedical subjects

M Torres-Tortosa

Publications and source records attributed to M Torres-Tortosa.

At least 19 recordsLinked to original sources
PubMed2002

Usefulness of sputum culture for diagnosis of bacterial pneumonia in HIV-infected patients.

The use of sputum culture in immunocompetent patients with community-acquired pneumonia is controversial. The usefulness of this technique in HIV-infected patients has not been evaluated. A prospective, observational, multicenter, hospital-based study of bacterial community-acquired pneumonia was carried out to analyze the value of sputum culture in HIV-infected patients. Only good-quality sputum samples were cultured. Altogether, 355 cases of bacterial community-acquired pneumonia were included. An etiological diagnosis was obtained in 190 (53.5%) cases. Sputum was cultured in 313 (88.1%) cases, being diagnostic in 108 (34.5%). The microorganism identified in sputum culture was the same as that identified in sterile samples in 26 of 27 (96.3%) cases in which both cultures were diagnostic. The microbiologic findings in sputum and bronchoscopic cultures were concordant in seven of eight (87.5%) cases in which both were positive. These results suggest that sputum culture is a useful technique, given its availability and ease of performance and its good correlation with culture of sterile samples.

AIDS-Related Opportunistic Infections↗
PubMed2002

Prognostic evaluation of bacteremia and fungemia in patients with acquired immunodeficiency syndrome.

The incidence of bacterial infections in general and of bacteremia in particular is high among patients with acquired immunodeficiency syndrome (AIDS). The factors influencing the prognosis of bacteremia in these patients are not well known. In order to better define those factors associated with a poor prognosis, all episodes of bacteremia or fungemia in patients with AIDS who were hospitalized in four general hospitals between 1 September 1987 and 31 December 1996 were studied prospectively. Among 1,390 patients diagnosed with AIDS, 238 (17.1%) developed 274 episodes of bacteremia or fungemia. Mortality related to bacteremia was 21.3%. Variables associated with high mortality were fungemia (odds ratio [OR], 6.19; 95% confidence interval [CI], 1.99 - 19.28), hypotension (OR, 19.65; 95%CI, 7.42 - 52.07), inappropriate antimicrobial treatment (OR, 16.94; 95%CI, 4.92 - 58.32), and unknown origin of bacteremia (OR, 3.93; 95%CI, 1.58 - 9.76). The mortality rate among patients with at least one of these factors was 46.7%, whereas in patients without any of these factors, the rate was 4.9% ( P < 0.001). Bacteremic episodes of unknown origin were significantly more frequently associated with community acquisition ( P = 0.001), inappropriate antimicrobial treatment ( P = 0.04), and etiology by gram-negative microorganisms or fungi ( P < 0.001) and were significantly less frequently associated with the presence of a previous intravenous catheter ( P = 0.004), resulting in peculiar etiologic and epidemiological profiles. The factors that influence the outcome of AIDS patients who develop bacteremia are sometimes avoidable or known during the first days after admission. Therefore, knowledge about these factors could improve the prognosis of bloodstream infections in this population.

AIDS-Related Opportunistic Infections↗
PubMed2000

Haemophilus influenzae pneumonia in human immunodeficiency virus-infected patients. The Grupo Andaluz para el Estudio de las Enfermedades Infecciosas.

Although Haemophilus influenzae is a common etiologic agent of pneumonia in patients infected with human immunodeficiency virus (HIV), the characteristics of this pneumonia have not been adequately assessed. We have prospectively studied features of H. influenzae pneumonia in 26 consecutive HIV-infected inpatients. Most of these patients were severely immunosuppressed; 73.1% had a CD4+ cell count <100/microL. A subacute clinical presentation was observed in 27% of the patients and was associated with a higher degree of immunosuppression (P=.04). Bilateral lung infiltrates were noted radiographically in 57.7% of the cases. The mortality attributable to H. influenzae pneumonia was 11.5%. Thus, pneumonia caused by H. influenzae affects mainly patients with advanced HIV disease, and since its clinical and radiological features may be diverse, this etiology should be considered when pneumonia occurs in patients with advanced HIV infection. The mortality rate associated with H. influenzae pneumonia is not higher than that occurring in the general population.

AIDS-Related Opportunistic Infections↗
PubMed2000

Community-acquired bacterial pneumonia in human immunodeficiency virus-infected patients: validation of severity criteria. The Grupo Andaluz para el Estudio de las Enfermedades Infecciosas.

Severity criteria for community-acquired pneumonia (CAP) have always excluded patients with human immunodeficiency virus (HIV) infection. A 1-yr, multicenter, prospective observational study of HIV-infected patients with bacterial CAP was done to validate the criteria used in the American Thoracic Society (ATS) guidelines for CAP, and to determine the prognosis-associated factors in the HIV-infected population with bacterial CAP. Overall, 355 cases were included, with an attributable mortality of 9.3%. Patients who met the ATS criteria had a longer hospital stay (p = 0.01), longer duration of fever (p < 0.001), and higher attributable mortality (13.1% versus 3.5%, p = 0.02) than those who did not. Three factors were independently related to mortality: CD4(+) cell count < 100/microl, radiologic progression of disease, and shock. Pleural effusion, cavities, and/or multilobar infiltrates at admission were independently associated with radiologic progression. A prognostic rule based on the five criteria of shock, CD4(+) cell count < 100/microl, pleural effusion, cavities, and multilobar infiltrates had a high negative predictive value for mortality (97.1%). The attributable mortality for severe pneumonia was 11.3%, as compared with 1.3% for nonsevere disease (p = 0.008). The ATS severity criteria are valid in HIV-infected patients with bacterial CAP. Our study provides the basis for identification of patients who may require hospitalization determined by clinical judgment and the five clinical criteria of shock, a CD4(+) cell count < 100/microl, pleural effusion, cavities, and multilobar involvement. These prognostic factors should be validated in independent cohort studies.

AIDS-Related Opportunistic Infections↗
PubMed1998

Comparative study of bacteremias caused by Enterococcus spp. with and without high-level resistance to gentamicin. The Grupo Andaluz para el estudio de las Enfermedades Infecciosas.

A prospective, multicenter study was carried out over a period of 10 months. All patients with clinically significant bacteremia caused by Enterococcus spp. were included. The epidemiological, microbiological, clinical, and prognostic features and the relationship of these features to the presence of high-level resistance to gentamicin (HLRG) were studied. Ninety-three patients with enterococcal bacteremia were included, and 31 of these cases were caused by HLRG (33%). The multivariate analysis selected chronic renal failure, intensive care unit stay, previous use of antimicrobial agents, and Enterococcus faecalis species as the independent risk factors that influenced the development of HLRG. The strains with HLRG showed lower levels of susceptibility to penicillin and ciprofloxacin. Clinical features (except for chronic renal failure) were similar in both groups of patients. HLRG did not influence the prognosis for patients with enterococcal bacteremia in terms of either the crude mortality rate (29% for patients with bacteremia caused by enterococci with HLRG and 28% for patients not infected with strains with HLRG) or the hospital stay after the acquisition of enterococcal bacteremia. Hemodynamic compromise, inappropriate antimicrobial therapy, and mechanical ventilation were revealed in the multivariate analysis to be the independent risk factors for mortality. Prolonged hospitalization was associated with the nosocomial acquisition of bacteremia and polymicrobial infections.

Adult↗
PubMed1998

[Other infections (Streptococcus pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, Salmonella spp., Campylobacter spp., Nocardia asteroides, Rhodococcus equi and Bartonella spp.)].

People infected with human immunodeficiency virus (HIV) are at increased risk for bacterial infections due to HIV-associated immunologic defects. Bacterial infections were found to be, both a predictor of progression to AIDS and a substantial cause of mortality in pre-AIDS stages. Most bacterial infections are caused by Streptococcus pneumoniae, Haemophilus influenzae, Salmonella spp. and Pseudomonas aeruginosa. Rhodococcus equi, Nocardia spp., Campylobacter spp. and Bartonella spp. are less common. Data derived from two AIDS Clinical Trials Group studies showed that the most common bacterial infections were sinusitis (8.5 per 100 episodes per person years [py]), bacterial pneumonia (5.0 per 100 py), bronchitis (4.1 per 100 py) and soft tissue infections (3.5 per 100 py). In this review clinical characteristics and treatment recommendations according to data available in the literature for these infections are summarized.

AIDS-Related Opportunistic Infections↗
PubMed1997

[Bacteremias due to the Streptococcus milleri group. An analysis of 18 episodes].

OBJECTIVE: To study the epidemiological and clinical characteristics of bacteremia caused by Streptococcus milleri group streptococci (SMG). METHODS: Prospective evaluation of all bacteremic episodes with clinical significance from 1990 to 1995 in two general hospitals. In this study all episodes caused by SMG were analyzed. RESULTS: A total of 905 bacteremic episodes with clinical significance were detected; 18 (1.98%) were caused by SMG (0.16/1,000 admissions). The mean age of patients were 43 years and the male/female ratio 1.6. Seventeen patients (94.4%) had some underlying disease; nine patients had diabetes, four were parenteral drug abusers, and two had neoplasms. The most common sources of bacteremia were intraabdominal in four episodes (two liver abscesses, one subphrenic abscess and one pancreatic pseudocyst), cutaneous and/or soft tissues in four, surgical wound in two and respiratory in two; no source was identified in five episodes. Four episodes had a polymicrobial origin. In 13 isolates the identification was at species level (Streptococcus anginosus eight, Streptococcus intermedius four and Streptococcus constellatus one). All strains were susceptible to penicillin. Six patients (33.3%) required surgery. In ten episodes a favorable outcome was recorded, although four patients required surgery. The infection associated mortality rate was 31.2%. The mean age of deceased patients was higher than for cured patients (62.2 +/- 20.2 versus 35.3 +/- 20.3; p < 0.05). CONCLUSIONS: SMB bacteremia is uncommon. It involved mainly diabetic patients or parenteral drug abusers, commonly with an intraabdominal suppurative source or in skin or soft tissues. The mortality rate was high despite surgery in one third of patients. Patients with advanced age had a poorer prognosis. All isolates investigated were susceptible to penicillin.

Adolescent↗
PubMed1996

Prospective evaluation of fever of unknown origin in patients infected with the human immunodeficiency virus. Grupo Andaluz para el Estudio de las Enfermedades Infecciosas.

The aim of this study was to determine the frequency and aetiology of fever of unknown origin (FUO) in patients infected with the human immunodeficiency virus (HIV), to assess the value of the tests used in its diagnosis, and to evaluate possible models of diagnosis for the causes found most frequently. One hundred twenty-eight (3.5%) of 3603 hospitalised HIV-positive patients evaluated from October 1992 to December 1993 had FUO, defined by established criteria. Eighty-six percent of patients with FUO had previously progressed to AIDS. The median CD4+ cell count was 46/mm3. A definite diagnosis was made in 96 (75%) of the 128 patients and a possible diagnosis in 24 (18.7%). whilst no diagnosis was made in eight cases (6.2%). Tuberculosis (48.3%), visceral leishmaniasis (16%), and infection by Mycobacterium avium complex (6.9%) were the diseases found most frequently. The most useful diagnostic tests were liver biopsy (68.9%) and bone marrow aspirate/biopsy (39.7%). It is not possible to predict clinically the cases of FUO due to tuberculosis, whilst thrombocytopaenia < 100,000 cells/mm3 alone is useful for differentiating the cases of visceral leishmaniasis, with a negative predictive value of 95.2%.

Adolescent↗
PubMed1995

[Changes in heroin administration route and frequency of human immunodeficiency virus infection].

BACKGROUND: Self-administration of drugs by different intravenous routes may induce a reduction in the organic complications of drug addiction (DA). The aim of this study was to evaluate the changes in the way of drug administration in a series of DA individuals in the province of Cádiz, Spain, and the evolution of the frequency of infection by the human immunodeficiency virus (HIV) in these patients. METHODS: The reports of all the drug users from the province of Cádiz admitted to the Detoxication Unit of the Hospital Punta de Europa in Algeciras, from January, 1989 to July, 1993 were reviewed. At the time of admission many data were evaluated, fundamentally the main route of drug administration, and anti-HIV seropositivity. RESULTS: Seven hundred ten drug users were included in the study. Ninety-seven percent used mainly heroin. The route of drug administration on admission was intravenous in 56.1%, pulmonary in 39.7%, inhalatory in 3.2% and oral in 0.8%. Forty-one point seven percent patients were seropositive for HIV. The frequency of the use of the intravenous route throughout the semesters analyzed was I/89: 85.7%, II/89: 89.6%, I/90: 80%, II/90: 80.8%, I/91: 59.8%, II/91: 50%, I/92: 44.9%, II/92: 39%, I/93: 34.3% (p < 0.00001). The use of the respiratory route significantly increased. The percentage of anti HIV positivity in the drug users evaluated was 67.4, 80.8, 56.4, 46.9, 40.7, 34.1, 30.6, 36.3, 23.2% (p < 0.00001), respectively for the same periods. The decrease in the use of the intravenous route and the reduction in anti HIV seropositivity demonstrated a correlation coefficient of 0.91 with a confidence interval from 0.62 to 0.98 (p < 0.05). CONCLUSIONS: The decrease, over time, in the use of the intravenous route for heroin administration in the collective analyzed was significantly associated with a decrease in HIV infection in these patients.

Adult↗
PubMed1994

Prospective evaluation of a two-week course of intravenous antibiotics in intravenous drug addicts with infective endocarditis. Grupo de Estudio de Enfermedades Infecciosas de la Provincia de Cádiz.

In a prospective study, a two-week course of antibiotics (cloxacillin 2 g/4 h plus amikacin 7.5 mg/kg/12 h) was evaluated in the therapy of right-sided infective endocarditis in intravenous drug users (IVDU). All IVDU admitted to hospital during the study period who fulfilled the strict criteria for diagnosis of infective endocarditis were analysed. A subgroup of patients with right-sided endocarditis caused by Staphylococcus aureus who had a good prognosis were selected as being eligible for the two-week course of treatment. In a total of 139 episodes of infective endocarditis in IVDU, 72 (51.8%) cases were eligible for the two-week treatment. Of this group, 67 were cured, 4 needed prolongation of treatment to cure the infection and 1 died in hospital of respiratory distress syndrome on day 10 of treatment. In patients not eligible for the two-week treatment, the mortality was higher (24.2% versus 0.7%; p = 0.00015). Drug toxicity in the treated group was low. It can be concluded that administration of cloxacillin and amikacin parenterally for 14 consecutive days was successful in the therapy of right-sided endocarditis in IVDU.

Adult↗
PubMed1994

[Clinical characteristicsand course of extrapulmonary/disseminated tuberculosis in patients with AIDS. Study of 103 cases diagnosed in the province of Cadiz].

Tuberculosis constitutes a public health problem that has become more serious in the past couple of years primarily due to the pandemic of human immunodeficiency virus (HIV). This study analyzes the evolutionary, clinical, and epidemiological characteristics of the extrapulmonary and disseminated forms of tuberculosis (TBD/E) in AIDS patients diagnosed in the province of Cádiz. Data for 103 patients who manifested both diseases were gathered prospectively. The prevalence of TBD/E was 30 percent among patients with AIDS. The primary risk factor was addiction to parenteral drugs (91 percent). Seventy-five percent of the patients were diagnosed with disseminated forms of the illness and 25 percent with extrapulmonary forms. The organs affected tended to be lymphatic ganglions and the lungs. Worthy of note is the lateness in seeking medical attention (45.6 +/- 4.5 days; range: 4-240 days). We conclude that tuberculosis constitutes a common pathology with an appreciable mortality in AIDs patients. Disseminated forms of tuberculosis predominate and may adopt a wide range of clinical manifestations. The lateness with which patients seek medical attention is a fact worth emphasizing.

Acquired Immunodeficiency Syndrome↗
PubMed1994

[Bacteremia caused by Campylobacter jeikeium in 2 AIDS patients without neutropenia].

BACKGROUND: Bacteremia by Corynebacterium jeikeium is generally described in patients with a bone marrow transplantation and/or neutropenia. In 1991, the first case of bacteremia by C. jeikeium was described in a patient with AIDS and neutropenia. The aim of this study was to describe 2 cases of bacteremia by C. jeikeium in patients with AIDS without neutropenia. To the authors' knowledge, this presentation has not been described previously. METHODS: The bacteremia episode was related with a central venous catheter in both patients. The first patient was diagnosed of tuberculous lymphadenitis and cerebral toxoplasmosis and the second patient of disseminated tuberculosis. Both receive specific treatment for these diseases. Zidovudine was not administered. The bacteremia resolved in both cases after withdrawal of the catheter and antibiotic treatment with vancomycin. CONCLUSIONS: Bacteremia by Corynebacterium jeikeium should be considered in the differential diagnosis of febrile patients with AIDS and vascular catheters, even if granulocytopenia is not present. The isolation of C. jeikeium from blood in AIDS patients, particularly neutropenic patients, should be carefully evaluated by microbiologists and clinicians prior to discard it as a "contaminant".

AIDS-Related Opportunistic Infections↗