Search

A 47-year-old man presented with weight loss, bilateral calf pain, fever, hypertension, orchitis and oligoarthritis. Lab tests: anemia and elevated muscle enzymes. Resonance magnetic imaging: hyperintensity in gastrocnemius muscles (myositis). Histologic exam of the muscles: inflammatory infiltrate with atrophy and perifascicular regeneration. Treatment: methylprednisone (bolus) and cyclophosphamide. Muscle pain and swelling and difficulty in walking are common in panarteritis nodosa (PAN), whereas histologically demonstrated myositis is not. Even more rare is myositis as the initial presentation of this vasculitis., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

The activity of moxifloxacin, a novel 8-methoxyquinolone, was evaluated against 1,218 respiratory pathogens isolated in nine Spanish hospitals and was compared with ciprofloxacin, sparfloxacin, amoxicillin, amoxicillin-clavulanic acid, cefuroxime, erythromycin and clarithromycin. Moxifloxacin exhibited an excellent in vitro activity against most tested isolates with MIC90 values of 0.25 mg/l for Streptococcus pneumoniae and viridans group streptococci; 0.12 mg/l for Streptococcus pyogenes; 0.25 mg/l for Streptococcus agalactiae; 0.06 and 4 mg/l for methicillin-susceptible and -resistant Staphylococcus aureus, respectively; 0.06 mg/l for Haemophilus influenzae and 0.12 mg/l for Moraxella catarrhalis. Moxifloxacin susceptibility rates were not affected by penicillin resistance in S. pneumoniae and S. viridans, by the betalactamase production in H. influenzae and M. catarrhalis or by macrolide resistance. Moxifloxacin was twice as active as sparfloxacin and four to sixteen times more active than ciprofloxacin against Gram-positive isolates. Sparfloxacin and ciprofloxacin were slightly more active than moxifloxacin when tested against H. influenzae and M. catarrhalis isolates. The microbiological data obtained confirm that moxifloxacin is a promising antimicrobial agent for treating respiratory tract infections.

The so-called wide spectrum beta-lactamases (WSBLs) are able to hydrolyze wide spectrum cephalosporins or monobactamics such as cefotaxime, ceftriaxone, ceftazidime, cefepime, cefpiroma or aztreonam. The natural wide spectrum beta-lactamases are mutational variants of TEM-1 consisting in the substitution of one of more amino acids within seven well defined positions in the molecule. Given the expected extremely low frequency for the simultaneous production of double or triple mutations, it is plausible that one of the mutational changes has been independently selected. A plurimutational remodelling of the TEM-beta-lactamase molecule is successively produced with the consequent appearance of highly effective ESBLs. Mutagenesis techniques allow clean molecular variants to be produced and allow the mutational effects under homogeneous conditions of bacterial strain, the plasmid implicated or the genic promotor to be studied. Meropenem remains active versus all the wide spectrum beta-lactamases referred in the 2be group of Bush, Jacoby and Medeiros as well as the new beta-lactamases produced in vitro by directed mutagenesis.