167 results on '"Fernández Guerrero ML"'
Search Results
2. Infective endocarditis at autopsy: a review of pathologic manifestations and clinical correlates.
- Author
-
Fernández Guerrero ML, Alvarez B, Manzarbeitia F, Renedo G, Fernández Guerrero, Manuel L, Álvarez, Beatriz, Manzarbeitia, Félix, and Renedo, Guadalupe
- Published
- 2012
- Full Text
- View/download PDF
3. Endocarditis caused by Staphylococcus aureus: A reappraisal of the epidemiologic, clinical, and pathologic manifestations with analysis of factors determining outcome.
- Author
-
Fernández Guerrero ML, González López JJ, Goyenechea A, Fraile J, de Górgolas M, Fernández Guerrero, Manuel L, González López, Julio J, Goyenechea, Ana, Fraile, Julián, and de Górgolas, Miguel
- Published
- 2009
- Full Text
- View/download PDF
4. Enterococcal endocarditis on native and prosthetic valves: a review of clinical and prognostic factors with emphasis on hospital-acquired infections as a major determinant of outcome.
- Author
-
Fernández Guerrero ML, Goyenechea A, Verdejo C, Roblas RF, de Górgolas M, Fernández Guerrero, Manuel L, Goyenechea, Ana, Verdejo, Carlos, Roblas, Ricardo Fernández, and de Górgolas, Miguel
- Published
- 2007
- Full Text
- View/download PDF
5. Cutaneous and medullar gnathostomiasis in travelers to Mexico and Thailand.
- Author
-
de Górgolas M, Santos-O'Connor F, Gárate T, Troyas RMG, Unzú AL, Grobusch MP, Fernández-Guerrero ML, Górgolas, Miguel de, Santos-O'Connor, Francisco, Unzú, A López, Fernández-Guerrero, Manuel L, Gárate, Teresa, Troyas Guarch, Rosa María, and Grobusch, Martin P
- Abstract
Gnathostomiasis is a rare nematode disease acquired by travelers to endemic areas. The most common clinical presentations are cutaneous forms; however, neurologic involvement can also occur. We present two cases of gnathostomiasis, one of them with severe neurologic complications, in Spanish travelers to Thailand and Mexico, who consumed local food and became infected. [ABSTRACT FROM AUTHOR]
- Published
- 2003
6. Bone marrow biopsy in the diagnosis of fever of unknown origin in patients with acquired immunodeficiency syndrome.
- Author
-
Benito N, Núñez A, de Górgolas M, Esteban J, Calabuig T, Rivas MC, and Fernández Guerrero ML
- Published
- 1997
- Full Text
- View/download PDF
7. Postcraniotomy Mycetoma of the Scalp and Osteomyelitis Due to Pseudallescheria boydii
- Author
-
Fernández-Guerrero Ml, Alés Jm, and Ruiz Barnés P
- Subjects
medicine.medical_specialty ,biology ,business.industry ,Osteomyelitis ,biology.organism_classification ,medicine.disease ,Dermatology ,Pseudallescheria boydii ,Infectious Diseases ,medicine.anatomical_structure ,Scalp ,Immunology and Allergy ,Medicine ,business ,Mycetoma - Published
- 1987
8. Drug points: fatal lactic acidosis associated with tenofovir.
- Author
-
Rivas P, Polo J, de Górgolas M, and Fernández-Guerrero ML
- Published
- 2003
- Full Text
- View/download PDF
9. Zidovudine and red-cell distribution width.
- Author
-
Rivas P, Górgolas M, and Fernández-Guerrero ML
- Published
- 2005
10. Anorectal Lymphogranuloma Venereum in Madrid: A Persistent Emerging Problem in Men Who Have Sex With Men.
- Author
-
Cabello Úbeda A, Fernández Roblas R, García Delgado R, Martínez García L, Sterlin F, Fernández Guerrero ML, and Górgolas M
- Subjects
- Adult, Homosexuality, Male, Humans, Lymphogranuloma Venereum complications, Lymphogranuloma Venereum epidemiology, Lymphogranuloma Venereum pathology, Male, Middle Aged, Proctitis pathology, Rectal Diseases complications, Rectal Diseases epidemiology, Rectal Diseases pathology, Sexually Transmitted Diseases complications, Sexually Transmitted Diseases epidemiology, Sexually Transmitted Diseases pathology, Spain epidemiology, Unsafe Sex, HIV Infections complications, Lymphogranuloma Venereum diagnostic imaging, Proctitis etiology, Rectal Diseases diagnostic imaging, Sexually Transmitted Diseases diagnostic imaging
- Abstract
Background: Since 2003, outbreaks of lymphogranuloma venereum (LGV) with anorectal syndrome have been increasingly recognized in many Western countries. All of them have been classified as LGV serovar L2b, mainly occurring in human immunodeficiency virus (HIV)-infected men who have had sex with men (MSM). We describe a series of 26 diagnosed cases of LGV proctitis in downtown Madrid, Spain, in 2014, after implementing routine diagnostic procedures for this disease in symptomatic MSM., Methods: We conducted an observational study of patients with symptomatic proctitis attending an outpatient infectious diseases clinic in Madrid, Spain during calendar year 2014. Clinical, epidemiological, laboratory, and therapeutic data were gathered and analyzed., Results: Twenty-six patients were included in the analysis. All were MSM, and 24 of them were HIV-positive. All patients reported having acute proctitis symptoms including tenesmus (85%), pain (88%), constipation (62%), or anal discharge (96%). Proctoscopy showed mucopurulent exudate (25 patients [96%]), and rectal bleeding, with mucosal erythema and/or oedema in all cases. Rectal swabs were obtained from all patients, and LGV serovar L2 was confirmed in all of them. The cure rate was 100% after standard treatments with doxycycline 100 mg twice per day for 3 weeks. Simultaneous rectal infections with other sexually transmitted pathogens (gonorrhoea, herpes simplex virus, Mycoplasma genitalium) and systemic sexually transmitted diseases (STDs) (syphilis, acute HIV, and hepatitis C infections) were also documented in 12 patients (46%), but these co-infections did not appear to influence the clinical manifestations of LGV., Conclusions: Anorectal LGV is a common cause of acute proctitis and proctocolitis among HIV-infected MSM who practice unprotected anal sex, and it is frequently associated with other rectal STDs. The implementation of routine screening and prompt diagnosis of these rectal infections should be mandatory in all clinical settings attended by HIV and STD patients.
- Published
- 2016
- Full Text
- View/download PDF
11. [Cryptococcal meningoencephalitis. Epidemiology and mortality risk factors in pre- and post-HAART era].
- Author
-
Cabello Úbeda A, Fortes Alen J, Gadea I, Mahillo I, Górgolas M, and Fernández Guerrero ML
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, Adult, Antiretroviral Therapy, Highly Active, Cryptococcosis diagnosis, Female, Follow-Up Studies, HIV Infections drug therapy, Humans, Male, Meningoencephalitis diagnosis, Middle Aged, Retrospective Studies, Risk Factors, Spain epidemiology, AIDS-Related Opportunistic Infections epidemiology, Cryptococcosis epidemiology, Meningoencephalitis epidemiology
- Abstract
Introduction and Objective: Cryptococcal meningoencephalitis (CM) is an uncommon entity, but remains a major cause of morbidity and mortality in patients with AIDS., Material and Methods: Review of CM cases in a university hospital. The diagnosis was determined by isolation of Cryptococcus neoformans in cerebrospinal fluid. Morbidity and mortality was assessed at 12 weeks (early mortality) and between 3 and 18 months after diagnosis (late mortality)., Results: We analyzed 32 patients from 2,269 AIDS cases (1.41%). 10 patients between 1990-1996 and 22 between 1997-2014. Cryptococcal antigen in CSF was positive in all cases, with titers>1,024 in 19 patients (63%); this group had lower CD4+ counts (40 ± 33 vs. 139 ± 78 cel/μL) and greater disseminated involvement. After a first CM episode the relapse rate was 34%. Global mortality rate was 28% (9/32), much higher in the pre-HAART era., Conclusions: CM morbidity and mortality is related to severe immunodeficiency, disseminated disease, high titers of antigen in CSF and delayed initiation of HAART., (Copyright © 2016 Elsevier España, S.L.U. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
12. Tolerance and safety of intravenous streptomycin therapy in patients with tuberculosis.
- Author
-
Pérez Tanoira R, Sánchez-Patán F, Jiménez Girón A, Fernández Roblas R, Esteban J, and Fernández Guerrero ML
- Subjects
- Administration, Intravenous, Adult, Antitubercular Agents administration & dosage, Female, Humans, Inpatients, Male, Middle Aged, Streptomycin administration & dosage, Antitubercular Agents adverse effects, Streptomycin adverse effects, Tuberculosis drug therapy
- Published
- 2014
- Full Text
- View/download PDF
13. [Q fever in Spain: "an inconclusive history"].
- Author
-
Fernández Guerrero ML
- Subjects
- Humans, Spain, Q Fever diagnosis, Q Fever epidemiology
- Published
- 2014
- Full Text
- View/download PDF
14. [Practices and perception of risk in human immunodeficiency virus infected males who have sex with other males].
- Author
-
Fernández de Mosteyrín S, del Val Acebrón M, Fernández de Mosteyrín T, and Fernández Guerrero ML
- Subjects
- Adult, Aged, Aged, 80 and over, Humans, Male, Middle Aged, Prospective Studies, Risk, Surveys and Questionnaires, Young Adult, Attitude to Health, HIV Infections prevention & control, HIV Infections transmission, Health Knowledge, Attitudes, Practice, Homosexuality, Male
- Abstract
Introduction: The incidence of human immunodeficiency virus (HIV) and other sexually transmitted diseases increases in males who have sex with males (MSM), despite the knowledge on how to prevent them. To determine the mechanisms that are driving this lack of prevention is important to reverse the trend., Patients and Methods: An anonymous, voluntary and self-reporting questionnaire was completed by HIV+ MSM patients who were seen in a hospital clinic, with the aim of finding out the sexual risk practices and behaviour, as well as their perceptions and assessment as regards this risk. The questionnaire included 58questions, divided into 10sections, to explore the knowledge, attitudes, and behaviour as regards HIV. The questionnaires were also given to the physicians, with the aim of exploring their perceptions, attitudes and opinions as regards the situation of the epidemic, prevention, perception of the diseases and the patient, and values in clinical practice., Results: A total of 495 questionnaires from the patients were analysed. Most of them (87%) said they knew how HIV was acquired, and 97% knew how to prevent it, but 69% knew they were in a risk situation, and 43% had little concern of contracting HIV. Almost two-thirds (65%) had sex with ≥2persons on the same day, 47% met on the Internet and 26% had group sex. The same percentage of those surveyed considered that they acted impulsively. They highlighted a lack of information (33%), bad luck (32%), assumed excessive risk (36%), and lake of concern (25%), as the main reasons for acquiring the infection. When confronted with diagnosis 41% of patients answered «I never thought that it would happen to me», and 32% said «I had bad luck». Of the 121 physicians who completed the questionnaire, 24% considered that infection due to HIV/AIDS was out of control in Spain, and 65% responded that there was an image that HIV/AIDS was a controlled disease and of little concern. A large majority (71%) of those surveyed, considered that the increase in new infections showed that there was no suitable preventive plan., Conclusions: The management of the risk of acquiring HIV maintains a low level of concern, due to the optimism produced by the advances in the fight against the disease and the current toning down of the discussion. The trivialisation of the risk, on distorting the idea of risky behaviour, is a determining factor of attitudes that makes it impossible to adopt effective preventive behaviour and to take sensible and anticipated decisions., (Copyright © 2012 Elsevier España, S.L. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
15. Risk factors and clinical significance of invasive infections caused by levofloxacin-resistant Streptococcus pneumoniae.
- Author
-
Isea-Peña MC, Sanz-Moreno JC, Esteban J, Fernández-Roblas R, and Fernández-Guerrero ML
- Subjects
- Chi-Square Distribution, Drug Resistance, Bacterial, Female, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Multivariate Analysis, Pneumonia, Pneumococcal drug therapy, Retrospective Studies, Risk Factors, Anti-Bacterial Agents pharmacology, Levofloxacin pharmacology, Pneumonia, Pneumococcal microbiology, Streptococcus pneumoniae drug effects, Streptococcus pneumoniae isolation & purification
- Abstract
Purpose: Fluoroquinolones are recommended for the treatment of pneumonia. The recognition of risk factors for invasive levofloxacin-resistant Streptococcus pneumoniae is important for the design of treatment., Methods: A retrospective review of cases of invasive pneumococcal infections in adults was undertaken. Epidemiologic data, predisposing factors, clinical variables, and outcome were recorded from previously established protocols. Antimicrobial susceptibility was determined by disk diffusion and the Etest method. Serotyping was performed by latex agglutination and Quellung reaction., Results: Twenty patients with infection caused by levofloxacin-resistant pneumococci [minimum inhibitory concentration (MIC) ≥2 μg/ml] were compared with 102 patients harboring levofloxacin-susceptible strains; 80% of levofloxacin-resistant pneumococci were resistant to ≥3 antibiotics but susceptible to penicillin. Most levofloxacin-resistant strains (80%) belonged to serotype 8. In comparison, only 8% of levofloxacin-susceptible pneumococci belonged to serotype 8. In the multivariate analysis, residence in public shelters [odds ratio (OR) 26.13; p 0.002], previous hospitalization (OR 61.77; p < 0.001), human immunodeficiency virus (HIV) infection (OR 28.14; p = 0.009), and heavy smoking (OR 14.41; p = 0.016) were associated with an increased risk of infection by levofloxacin-resistant pneumococci. Mortality caused by levofloxacin-resistant and levofloxacin-susceptible pneumococci was 35 and 14%, respectively. Among HIV-positive individuals infected with levofloxacin-resistant pneumococci 44% died, but only 12.5% of HIV-positive patients with levofloxacin-susceptible strains died., Conclusions: We observed the emergence of serotype 8 as the main cause of invasive disease caused by levofloxacin-resistant S. pneumoniae. HIV-positive patients seem to be prone to infection caused by multidrug-resistant serotype 8 and have a high mortality rate.
- Published
- 2013
- Full Text
- View/download PDF
16. Corynebacterium striatum: an emerging nosocomial drug-resistant endocardial pathogen.
- Author
-
Fernández Guerrero ML, Robles I, Nogales Mdel C, and Nuevo D
- Subjects
- Aged, Anti-Bacterial Agents administration & dosage, Cross Infection, Drug Resistance, Multiple, Bacterial, Humans, Male, Radiography, Thoracic Vertebrae diagnostic imaging, Treatment Outcome, Corynebacterium classification, Corynebacterium drug effects, Corynebacterium isolation & purification, Corynebacterium Infections diagnosis, Corynebacterium Infections drug therapy, Corynebacterium Infections etiology, Daptomycin administration & dosage, Discitis diagnostic imaging, Discitis drug therapy, Discitis etiology, Endocarditis, Bacterial diagnosis, Endocarditis, Bacterial drug therapy, Endocarditis, Bacterial etiology, Endocarditis, Bacterial microbiology, Epidural Abscess diagnostic imaging, Epidural Abscess drug therapy, Epidural Abscess etiology, Pacemaker, Artificial adverse effects
- Abstract
Endocarditis due to Corynebacterium striatum has been rarely reported. A 78-year-old patient developed pacemaker endocarditis caused by multidrug-resistant C. striatum, complicated by vertebral osteomyelitis and epidural abscess. Daptomycin therapy successfully eradicated the bacteremia and metastatic infection. A review of the English literature on this emerging nosocomial, multidrug-resistant pathogen is included.
- Published
- 2013
17. Multidrug-resistant Corynebacterium striatum endocarditis successfully treated with daptomycin.
- Author
-
Fernández Guerrero ML, Molins A, Rey M, Romero J, and Gadea I
- Subjects
- Aged, Corynebacterium drug effects, Corynebacterium Infections drug therapy, Corynebacterium Infections microbiology, Endocarditis, Bacterial drug therapy, Endocarditis, Bacterial microbiology, Humans, Male, Treatment Outcome, Anti-Bacterial Agents administration & dosage, Corynebacterium isolation & purification, Corynebacterium Infections diagnosis, Daptomycin administration & dosage, Drug Resistance, Multiple, Bacterial, Endocarditis, Bacterial diagnosis
- Published
- 2012
- Full Text
- View/download PDF
18. Antimicrobial treatment of invasive non-perinatal human listeriosis and the impact of the underlying disease on prognosis.
- Author
-
Fernández Guerrero ML, Torres R, Mancebo B, González-López JJ, Górgolas M, Jusdado JJ, and Roblas RF
- Subjects
- Adult, Aged, Comorbidity, Female, Hospitals, University, Humans, Incidence, Liver Cirrhosis complications, Male, Middle Aged, Neoplasms complications, Prognosis, Retrospective Studies, Spain epidemiology, Survival Analysis, Anti-Infective Agents administration & dosage, Listeriosis drug therapy, Listeriosis mortality
- Abstract
Listeriosis is a resurgent foodborne disease in European countries. Benefits of combined β-lactam-aminoglycoside treatment remain controversial and the impact of the underlying disease on prognosis has not been fully assessed. We conducted a retrospective review of cases of sporadic listeriosis in adults from 1995 to 2008 at two university-affiliated hospitals serving a population of 600,000 people in Madrid, Spain. The primary end-point was the associated in-hospital mortality. Sixty-four patients were studied. Estimated incidence of listeriosis was 0.76/100.000 persons/year. Seventy-four per cent had chronic underlying diseases; cirrhosis of the liver and haematological and solid neoplasias were the most common comorbidities. Primary bacteraemia (58%) and meningitis (42%) were the most frequent manifestations. Focal infections were seen in ten cases. In-hospital mortality was 31%. Patients treated with ampicillin or with an ampicillin-gentamicin combination did not differ in age, severity of underlying disease or type of presentation. Differences in mortality were not seen between patients treated with monotherapy and those given combined treatment (28% vs 35%; p 0.634). Ten patients were treated with trimethoprim-sulfamethozaxole alone and only one died. All patients without comorbidities survived infection but mortality of patients with cirrhosis of the liver was 21% and that of patients with haematological or solid neoplasias was 66%. Only haematological neoplasia (OR 6.67; 95% CI 1.71-26.04; p 0.006) was significantly associated with an increased risk of mortality (R(2) (Cox-Snell) = 0.262). Mortality of listeriosis mainly depended on the severity of the underlying disease. Combined ampicillin-gentamicin therapy did not improved survival. Trimethoprim-sulfamethozaxole may be an effective alternative therapy for listerial infections., (© 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.)
- Published
- 2012
- Full Text
- View/download PDF
19. [Memories of AIDS: lost opportunities].
- Author
-
Fernández de Mosteyrín S, Acebrón V, and Fernández Guerrero ML
- Subjects
- Acquired Immunodeficiency Syndrome history, Health Promotion, History, 20th Century, Humans, Acquired Immunodeficiency Syndrome prevention & control
- Published
- 2012
- Full Text
- View/download PDF
20. Acute polyarthritis as sole manifestation of meningococcal disease.
- Author
-
Rodríguez CL, Octavio JG, Isea C, Petkova E, Pernaute OS, and Fernández Guerrero ML
- Subjects
- Acute Disease, Aged, 80 and over, Anti-Bacterial Agents therapeutic use, Arthritis, Infectious drug therapy, Arthritis, Infectious microbiology, Ceftriaxone therapeutic use, Female, Fever diagnosis, Humans, Leukocyte Count, Male, Meningococcal Infections drug therapy, Meningococcal Infections microbiology, Middle Aged, Arthritis, Infectious diagnosis, Meningococcal Infections diagnosis, Neisseria meningitidis isolation & purification
- Published
- 2012
- Full Text
- View/download PDF
21. Pulmonary infectious diseases in patients with primary immunodeficiency and those treated with biologic immunomodulating agents.
- Author
-
Alvarez B, Arcos J, and Fernández-Guerrero ML
- Subjects
- Antibodies, Monoclonal adverse effects, Antibodies, Monoclonal, Murine-Derived adverse effects, Biological Products adverse effects, Humans, Infliximab, Opportunistic Infections etiology, Rituximab, Communicable Diseases etiology, Immunologic Deficiency Syndromes complications, Immunomodulation, Lung Diseases etiology
- Abstract
Purpose of Review: Lung infectious disease is an important cause of morbidity and mortality in patients with primary immunodeficiencies and other conditions that alter immunologic mechanisms against microbial invasion. Lung infectious diseases occurring in patients with congenital immunodeficiency and patients on treatment with biologic anti-inflammatory compounds are discussed. Understanding of the complex relationships between the immune system and microbes is of paramount importance for timely diagnosis and successful treatment of lung infectious diseases in this group of immunocompromised hosts., Recent Findings: In the past, only a minority of children with severe primary immunodeficiency survived beyond childhood and these disorders were within the scope of the pediatrician. As modern prophylaxis and treatment strategies have been implemented, these patients will now survive into adulthood. Nowadays, therapy with new biologic compounds--tumor necrosis factor (TNF) blockers and anti-CD20 drugs--that disrupt antimicrobial surveillance and the control of intracellular microorganisms such as mycobacteria, fungi and viruses has been associated with the emergence of a new population at risk for the development of severe pulmonary and disseminated infectious diseases., Summary: A wide array of bacteria, viruses, fungi and protozoa may cause severe pulmonary infectious diseases in patients with primary immunodeficiency and patients on treatment with anti-TNF and anti-CD20 drugs. Knowledge of the association of certain microbial agents with specific immune disturbances is of great clinical interest.
- Published
- 2011
- Full Text
- View/download PDF
22. Nevirapine-induced agranulocytosis.
- Author
-
Pérez Pedrero D, Górgolas M, and Fernández Guerrero ML
- Subjects
- Agranulocytosis diagnosis, Anti-HIV Agents therapeutic use, HIV immunology, HIV Seropositivity, Humans, Male, Middle Aged, Nevirapine therapeutic use, Agranulocytosis chemically induced, Anti-HIV Agents adverse effects, Nevirapine adverse effects
- Published
- 2011
- Full Text
- View/download PDF
23. Infectious endocarditis in patients with cirrhosis of the liver: a model of infection in the frail patient.
- Author
-
Fernández Guerrero ML, González López J, and Górgolas M
- Subjects
- Adult, Aged, Aged, 80 and over, Bacteria classification, Bacteria isolation & purification, Cross Infection epidemiology, Endocarditis, Bacterial microbiology, Endocarditis, Bacterial mortality, Endocarditis, Bacterial surgery, Female, Heart Valves pathology, Hospitals, University, Humans, Liver Cirrhosis mortality, Liver Cirrhosis pathology, Male, Middle Aged, Postoperative Complications epidemiology, Postoperative Complications mortality, Renal Insufficiency epidemiology, Severity of Illness Index, Endocarditis, Bacterial epidemiology, Liver Cirrhosis complications
- Abstract
The purposes of this paper was to discover whether cirrhosis is a predisposing cause of infectious endocarditis (IE) and to determine the microbiology, prognosis and the role of cardiac surgery on mortality. A review of cases of IE at a university-affiliated hospital over a period of 10 years was conducted. Thirty-one (9.8%) patients among 316 cases of IE had hepatic cirrhosis. Valve disorders were present in 62.2% of cirrhotic patients and infection occurred on the aortic (48%) and mitral valves (45%). Endocarditis was hospital-acquired in 14 (45%) and 11 (17.7%) cirrhotic patients and controls, respectively (odds ratio [OR] 3.82; 95% confidence interval [CI]: 1.46-9.99; p = 0.005). Staphylococcus aureus was the most common causative microorganism, but β-hemolytic streptococci were most frequently isolated in cirrhotic patients (OR 8.75; 95% CI: 1.7-45.2; p = 0.001). Renal failure was more frequent in patients with cirrhosis (OR 8.23; 95% CI: 3.06-22.2; p = 0.001). Cirrhotic patients had a higher mortality (51% vs. 17.7%; OR 4.95; 95% CI: 1.89-12.91; p = 0.001) associated with the severity of liver disease. Valve replacement was performed less frequently in cirrhotic patients (56.2% vs. 92%) and the operative mortality was extremely high in patients at stages B and C. Hepatic cirrhosis is a frequent comorbid condition in patients with endocarditis. Due to the presence of severe hepatic dysfunction, cardiac surgery is not undertaken even when indicated and mortality is high in stages B and C. Endocarditis is a serious hazard for hospitalized cirrhotic patients.
- Published
- 2010
- Full Text
- View/download PDF
24. Spontaneous epidural abscess: analysis of 15 cases with emphasis on diagnostic and prognostic factors.
- Author
-
González-López JJ, Górgolas M, Muñiz J, López-Medrano F, Barnés PR, and Fernández Guerrero ML
- Subjects
- Adult, Anti-Bacterial Agents therapeutic use, Cohort Studies, Drainage, Epidural Abscess etiology, Escherichia coli Infections etiology, Escherichia coli Infections therapy, Female, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Staphylococcal Infections etiology, Staphylococcal Infections therapy, Streptococcal Infections etiology, Streptococcal Infections therapy, Epidural Abscess diagnosis, Epidural Abscess therapy, Escherichia coli Infections diagnosis, Staphylococcal Infections diagnosis, Streptococcal Infections diagnosis, Streptococcus milleri Group
- Abstract
Purpose: To describe the incidence and characterize the clinical manifestations, diagnosis and outcome of spontaneous epidural abscess (SEA) not associated with neurosurgical procedures or instrumentation of the spine., Methods: Review of cases of SEA over 10 years. Diagnosis was made by imaging-techniques and surgical examination., Results: Fifteen patients were studied. The incidence of SEA was 0.4 cases per 100,000 person-years. Infection gained access to the epidural space haematogenously in 9 patients (60%). SEA was located at the lumbar (7 cases), cervical (4), cranial (2) and thoracic (1) areas. Local pain was the most common manifestation (93.3%); fever was absent in 40%. One third did not show neurologic abnormalities. Staphylococcus aureus was the most commonly isolated agent (87% of cases). All the patients received antimicrobial therapy for a mean period of 6.1+/-3.9 weeks. In addition, open surgical drainage or CT-guided needle aspiration was successfully performed in 10 and 3 patients respectively. Two patients were managed with antibiotics alone. Poor outcome occurred more frequently in patients with abscess at higher levels (67% in cranial or cervical abscesses versus 0% in thoracic or lumbosacral abscesses). An association was found between delayed diagnosis and poor outcome (p<0.05). Overall, 54% of our patients recovered without sequelae., Conclusions: SEA resulted from the extension of nearby or distant infections into the epidural space. Diagnosis was frequently delayed and the patient's neurologic status at presentation was the most important predictor of the outcome. The onset of spinal pain in patients with focal infections should prompt MRI of the spine, even in the absence of neurologic abnormalities or fever., (2009 European Federation of Internal Medicine.)
- Published
- 2009
- Full Text
- View/download PDF
25. Nodular lung schistosomiais lesions after chemotherapy for dysgerminoma.
- Author
-
de Górgolas M, Casado V, Renedo G, Alen JF, and Fernández Guerrero ML
- Subjects
- Adult, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Dysgerminoma secondary, Dysgerminoma surgery, Eosinophilia diagnosis, Female, Humans, Lung parasitology, Lung pathology, Lung Diseases, Parasitic drug therapy, Lung Diseases, Parasitic parasitology, Mali, Ovarian Neoplasms drug therapy, Ovarian Neoplasms surgery, Praziquantel therapeutic use, Retroperitoneal Neoplasms drug therapy, Schistosomiasis mansoni drug therapy, Schistosomicides therapeutic use, Travel, Dysgerminoma drug therapy, Eosinophilia parasitology, Lung Diseases, Parasitic pathology, Ovarian Neoplasms pathology, Retroperitoneal Neoplasms secondary, Schistosomiasis mansoni diagnosis
- Abstract
We report an unusual case of pulmonary schistosomiasis in a traveler to Mali that was diagnosed 16 months after primary infection, one month after she finished chemotherapy for a malignant tumor. Serologic analysis showed marked eosinophilia. Our case emphasizes the need to detect parasitic infections in cancer patients with unexplained eosinophilia, particularly in immigrants and travelers to tropical countries.
- Published
- 2009
26. Nephrotic syndrome complicating chronic visceral leishmaniasis: re-emergence in patients with AIDS.
- Author
-
Alex S, Criado C, Fernández-Guerrero ML, de Górgolas M, Petkov V, Garcia Perez A, Egido J, Barat A, Manzarbeitia F, Caramelo C, and Ortiz A
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections therapy, Adult, Chronic Disease, Female, Humans, Leishmaniasis, Visceral diagnosis, Leishmaniasis, Visceral therapy, Nephrotic Syndrome therapy, Recurrence, AIDS-Related Opportunistic Infections complications, Leishmaniasis, Visceral complications, Nephrotic Syndrome diagnosis, Nephrotic Syndrome etiology
- Abstract
Leishmania infection may be associated with immunecomplex-mediated glomerular injury. Contrary to immune-competent individuals, leishmaniasis in HIV patients is a chronic, relapsing disease. Despite the increasing frequency of the Leishmania/ HIV co-infection, there is a paucity of information on the effects of such co-infection in the kidney. We present a patient with AIDS and refractory, relapsing visceral leishmaniasis who developed nephrotic syndrome associated with renal involvement by Leishmania in the absence of immunecomplex glomerular deposition. For the first time, the relapsing nature of renal injury in this context is documented.
- Published
- 2008
- Full Text
- View/download PDF
27. Long term failure of miltefosine in the treatment of refractory visceral leishmaniasis in AIDS patients.
- Author
-
Troya J, Casquero A, Refoyo E, Fernández-Guerrero ML, and Górgolas M
- Subjects
- AIDS-Related Opportunistic Infections drug therapy, Adult, Animals, Female, HIV-1, Humans, Immunity, Cellular, Leishmaniasis, Visceral complications, Male, Middle Aged, Phosphorylcholine therapeutic use, Treatment Failure, Antiprotozoal Agents therapeutic use, Bone Marrow parasitology, HIV Infections complications, Leishmania donovani drug effects, Leishmaniasis, Visceral drug therapy, Phosphorylcholine analogs & derivatives
- Abstract
We carried out a retrospective and descriptive study of 4 HIV infected patients with relapsing visceral leishmaniasis (VL) seen at 2 tertiary-care hospitals in Spain during the last 6 y, in whom miltefosine was used as a compassionate use treatment at a dosage of 50 mg b.i.d. Patients had a medium CD4 lymphocyte count of 69 cells/microl and were C stage. All patients received at least 2 different anti-leishmanial drugs and had at least 3 relapses before miltefosine treatment (range 3-7). Three patients were treated with miltefosine at a standard dose of 50 mg b.i.d. for 28 d, and the other during 12 months. Despite an initial symptomatic improvement, miltefosine treatment failed to eradicate the infection in all cases. We conclude that the use of miltefosine alone is not strong enough to cure relapsing VL in HIV-1 controlled infected patients.
- Published
- 2008
- Full Text
- View/download PDF
28. Failure of isoniazid chemoprophylaxis during infliximab therapy.
- Author
-
Fernández-Guerrero ML, Esteban J, Acebes C, and Górgolas M
- Subjects
- Adult, Drug Interactions, Humans, Infliximab, Male, Mycobacterium kansasii isolation & purification, Treatment Failure, Anti-Inflammatory Agents therapeutic use, Antibodies, Monoclonal therapeutic use, Antitubercular Agents therapeutic use, Isoniazid therapeutic use, Mycobacterium Infections, Nontuberculous diagnosis
- Published
- 2007
- Full Text
- View/download PDF
29. The role of splenectomy in HIV-infected patients with relapsing visceral leishmaniasis.
- Author
-
Troya J, Casquero A, Muñiz G, Fernández-Guerrero ML, and Górgolas M
- Subjects
- Adult, Female, Humans, Male, Recurrence, Retrospective Studies, AIDS-Related Opportunistic Infections complications, AIDS-Related Opportunistic Infections therapy, HIV Infections complications, Leishmaniasis, Visceral complications, Leishmaniasis, Visceral therapy, Splenectomy
- Abstract
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.
- Published
- 2007
- Full Text
- View/download PDF
30. [Infectious endocarditis: "the microbe makes the difference"].
- Author
-
Fernández-Guerrero ML
- Subjects
- Angina, Unstable mortality, Aortic Valve, Endocarditis, Bacterial mortality, Heart Valve Diseases mortality, Heart Valve Diseases surgery, Humans, Myocardial Infarction mortality, Staphylococcal Infections mortality, Staphylococcus aureus isolation & purification, Syndrome, Endocarditis, Bacterial microbiology
- Published
- 2007
- Full Text
- View/download PDF
31. Comparative activity of cloxacillin and vancomycin against methicillin-susceptible Staphylococcus aureus experimental endocarditis.
- Author
-
Fernández Guerrero ML and de Górgolas M
- Subjects
- Animals, Disease Models, Animal, Endocarditis, Bacterial microbiology, Methicillin pharmacology, Microbial Sensitivity Tests, Rabbits, Staphylococcal Infections microbiology, Staphylococcus aureus isolation & purification, Anti-Bacterial Agents pharmacology, Cloxacillin pharmacology, Endocarditis, Bacterial drug therapy, Staphylococcal Infections drug therapy, Staphylococcus aureus drug effects, Vancomycin pharmacology
- Abstract
Objectives: To compare the activity of cloxacillin and vancomycin against methicillin-susceptible Staphylococcus aureus and to determine how rapidly their bactericidal activity occurs in cardiac vegetations., Methods: In vitro and in vivo studies using an experimental model of endocarditis in rabbits. Animals were treated for 1, 2 or 3 days with cloxacillin 200 mg/kg intramuscularly three times a day or vancomycin 25 mg/kg intravenously twice a day., Results: Cloxacillin and vancomycin at concentrations 4- and 16-fold the MIC produced a modest decrease in the number of microorganisms at 4 h. After 24 h, cloxacillin produced a decrease in the counts of staphylococci from 2.19 to 4.84 log10 cfu/mL of inoculum. Only concentrations of vancomycin from 16- to 32-fold the MIC resulted in equivalent decreases. After 24 h of treatment, both antibiotics were equally effective in preventing mortality of rabbits. Cloxacillin produced a greater decrease in the number of staphylococci than vancomycin (3.50+/-2.18 log10 cfu/g vegetation and 6.25+/-1.28 log10 cfu/g vegetation, respectively; P<0.05) and 41% of rabbits had sterile vegetations in comparison with none with vancomycin (P=0.035). After 48 and 72 h of treatment, both antimicrobials exhibited equivalent activity., Conclusions: Vancomycin was less rapidly bactericidal than cloxacillin in vivo.
- Published
- 2006
- Full Text
- View/download PDF
32. Infections of implantable cardioverter-defibrillators: frequency, predisposing factors and clinical significance.
- Author
-
Gil P, Fernández Guerrero ML, Bayona JF, Rubio JM, de Górgolas M, Granizo JJ, and Farré J
- Subjects
- Abdominal Wall, Aged, Bacterial Infections epidemiology, Bacterial Infections therapy, Cohort Studies, Defibrillators, Implantable microbiology, Female, Humans, Incidence, Male, Middle Aged, Postoperative Complications epidemiology, Postoperative Complications therapy, Prosthesis-Related Infections epidemiology, Prosthesis-Related Infections therapy, Retrospective Studies, Risk Factors, Spain epidemiology, Thoracic Wall, Time Factors, Bacteria isolation & purification, Bacterial Infections microbiology, Defibrillators, Implantable adverse effects, Postoperative Complications microbiology, Prosthesis-Related Infections microbiology
- Abstract
The prognosis for patients with ventricular arrhythmias has improved dramatically with the aid of implantable cardioverter-defibrillators (ICDs). Although infection is a serious complication that frequently causes dysfunction and loss of ICDs, the frequency, predisposing risk-factors, and clinical and microbiological features are only partially understood. This study describes a retrospective review of 423 procedures in 278 patients with ICD primary implants and replacements performed at a tertiary-care hospital. Generators were placed in either a pectoral (68%) or abdominal (32%) site, and electrodes were placed transvenously in 97% of the patients. Most (95%) interventions were performed in a one-stage procedure. Infection developed with ten (2.4%) implanted devices. Four cases occurred within 30 days of surgery ('early infections') and six occurred > 1 month after surgery ('late infections'). In univariate analysis, factors associated with the development of an early infection were: two-stage surgery, a sub-costal approach, and abdominal generator placement. In patients with late infections, a significant association was found with trauma or decubitus ulcer in the generator area. Infection presented with local signs without systemic complications. Seven of the ten patients required complete removal of the system.
- Published
- 2006
- Full Text
- View/download PDF
33. [Catheter-associated septic thrombophlebitis and arthritis due to penicillin-resistant Streptococcus pneumoniae].
- Author
-
Troya-García J, Salinas-Botrán A, González-Cajigal A, and Fernández-Guerrero ML
- Subjects
- Humans, Male, Middle Aged, Penicillin Resistance, Arthritis, Infectious etiology, Bacteremia etiology, Catheterization, Central Venous adverse effects, Pneumococcal Infections etiology, Streptococcus pneumoniae drug effects, Thrombophlebitis etiology
- Published
- 2006
- Full Text
- View/download PDF
34. Use of rituximab as a salvage therapy for HIV-associated multicentric Castleman disease.
- Author
-
Casquero A, Barroso A, Fernández Guerrero ML, and Górgolas M
- Subjects
- Antibodies, Monoclonal adverse effects, Antibodies, Monoclonal, Murine-Derived, Antineoplastic Agents adverse effects, Castleman Disease complications, Castleman Disease pathology, HIV Infections complications, HIV Infections pathology, Humans, Male, Middle Aged, Rituximab, Sarcoma, Kaposi complications, Sarcoma, Kaposi pathology, Antibodies, Monoclonal administration & dosage, Antineoplastic Agents administration & dosage, Castleman Disease drug therapy, HIV Infections drug therapy, Salvage Therapy methods, Sarcoma, Kaposi drug therapy
- Abstract
Several approved therapies for multicentric Castleman disease (MCD) cannot be uniformly applied due to intolerable side effects. There is also a high percentage of recurrence of this disease despite treatment. Rituximab may be effective in controlling MCD in a subset of patients. This paper includes a brief case report and an extensive review of previously published cases. We observed an aggravation of concomitant cutaneous Kaposi sarcoma, and hypothesize that rituximab could have exacerbated it.
- Published
- 2006
- Full Text
- View/download PDF
35. Pleuropulmonary infections caused by Mycobacterium bovis: a re-emerging disease.
- Author
-
Esteban J, Robles P, Soledad Jiménez M, and Fernández Guerrero ML
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Mycobacterium Infections, Nontuberculous drug therapy, Tuberculosis, Pulmonary epidemiology, Tuberculosis, Pulmonary etiology, AIDS-Related Opportunistic Infections microbiology, Mycobacterium Infections, Nontuberculous epidemiology, Mycobacterium bovis, Tuberculosis, Pulmonary microbiology
- Abstract
Between 1980 and 2003, 13 patients (0.95% of all cases of tuberculosis) at a 600-bed university hospital in Madrid, Spain, were diagnosed with Mycobacterium bovis infection. All 13 cases occurred between 1994 and 1999; the mean age of the patients was 50 years (range 23-83 years), and 77% were males. Four (30%) patients were also positive for human immunodeficiency virus (HIV). The most frequent localisation of the disease was the lung (ten patients; 77%). Seven patients, including four HIV-positive patients who died, had multidrug-resistant M. bovis infection. No other patient died, including two HIV-negative patients with multidrug-resistant disease.
- Published
- 2005
- Full Text
- View/download PDF
36. The impact of hospital-acquired infections on the microbial etiology and prognosis of late-onset prosthetic valve endocarditis.
- Author
-
Rivas P, Alonso J, Moya J, de Górgolas M, Martinell J, and Fernández Guerrero ML
- Subjects
- Adult, Cross Infection mortality, Endocarditis, Bacterial mortality, Female, Humans, Male, Middle Aged, Prognosis, Prosthesis-Related Infections mortality, Risk Factors, Time Factors, Cross Infection microbiology, Endocarditis, Bacterial microbiology, Heart Valve Prosthesis adverse effects, Prosthesis-Related Infections microbiology
- Abstract
Study Objectives: To study the changing etiology of prosthetic valve endocarditis (PVE) and the impact of nosocomial acquisition of the infection on prognosis in a single hospital., Methods: Retrospective review of 121 cases of PVE during a period of 34 years. Two different periods (the period from 1970 to 1986 [P1], and the period from 1987 to 2003 [P2]) were analyzed., Results: During P1, 58 patients with PVE were treated (30 early PVE and 28 late PVE); during P2, 63 patients with PVE were treated (13 early PVE and 50 late PVE). The frequency of early-onset PVE decreased from 0.94% in P1 to 0.34% in P2 (p < 0.001), but the incidence rate of late-onset PVE did not change (0.33% and 0.42% per year, respectively). The microbiology of early PVE changed over the years: Gram-negative bacilli decreased from 40% during P1 to 7.7% in P2 (p = 0.033). Staphylococci remained the main causes of early PVE in both periods. The microbial etiology of late PVE also changed over the years with enterococci and Staphylococcus aureus as the leading causes during P2. Streptococcus viridans decreased from a leading position to a fourth position. Methicillin-resistant S aureus endocarditis appeared first in 1992. Eleven cases of late-onset PVE in P2 were hospital acquired (22%). In comparison, only two cases (7.1%) of hospital-acquired, late-onset PVE were seen in P1 (p = 0.11). Mortality of early-onset PVE decreased from 80% in P1 to 46% in P2 (p = 0.026). The overall mortality of late-onset PVE did not change between periods: 39% vs 34%. Mortality associated with nosocomial PVE in P2 was 63.6% (7 of 11 patients). In comparison, the mortality of community-acquired cases was 25.6% (10 of 39 patients; p = 0.03). In the multivariate analysis, the presence of comorbidities and hospital acquisition were associated with an excess of mortality (odds ratio [OR], 13.9; 95% confidence interval [CI], 1.23 to 158 [p = 0.033]; and OR, 10.8; 95% CI, 2.16 to 54.7 [p = 0.0037], respectively)., Conclusion: Although the mortality associated with early-onset PVE has significantly decreased, in this series the mortality of patients with late-onset PVE remained high due mainly to an increasing number of patients with comorbidities who acquired the infection during admission for other diseases.
- Published
- 2005
- Full Text
- View/download PDF
37. Long-term follow-up of asymptomatic HIV-infected patients who discontinued antiretroviral therapy.
- Author
-
Fernández Guerrero ML, Rivas P, Molina M, Garcia R, and De Górgolas M
- Subjects
- Adult, Anti-HIV Agents economics, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Drug Administration Schedule, Female, Humans, Longitudinal Studies, Male, Middle Aged, RNA, Viral blood, Time Factors, Viral Load, Anti-HIV Agents administration & dosage, Anti-HIV Agents therapeutic use, HIV Infections drug therapy
- Abstract
Background: Whether asymptomatic human immunodeficiency virus (HIV)-infected patients can interrupt treatment remains unknown., Methods: We performed a prospective, observational study of 46 patients who started therapy with >300 CD4+ cells/mm3 and/or <70,0000 HIV-1 RNA copies/mL. Patients had been receiving highly active antiretroviral therapy (HAART) for at least 6 months. HAART was discontinued, and plasma HIV-1 RNA loads and CD4+ cell counts were determined at 4-month intervals., Results: At the time of HAART discontinuation, the median CD4+ cell count was 793 cells/mm3, and all patients had undetectable viral loads. A rapid decrease of 173 cells/mm3 in the median CD4+ cell count was observed during the first 4 months after HAART was stopped, followed by a slower decrease of 234 cells/mm3 between months 5 and 20. The decrease in the median CD4+ cell count early after HAART discontinuation was inversely correlated with the increase that occurred during receipt of therapy (r=-0.653) and with the count at the time of HAART discontinuation (r=-0.589). The decrease in the median CD4+ cell count after the fourth month without HAART was correlated with the nadir count before HAART initiation (r=-0.349) and the increase during treatment (r=-0.322). The median follow-up duration was 20 months. After 12, 24, and 36 months of observation, 33 patients (71.7%), 22 patients (47.8%), and 16 patients (34.7%), respectively, remained free of therapy. Adverse clinical events were not seen, and all patients who reinitiated HAART responded rapidly., Conclusion: Selected asymptomatic HIV-infected patients can safely discontinue therapy for prolonged periods of time.
- Published
- 2005
- Full Text
- View/download PDF
38. [Gnathostomiasis: an increasing disease among travellers].
- Author
-
de Górgolas Hernández-Mora M and Fernández Guerrero ML
- Subjects
- Animals, Antiparasitic Agents therapeutic use, Humans, Travel, Gnathostoma isolation & purification, Spirurida Infections diagnosis, Spirurida Infections drug therapy, Spirurida Infections epidemiology
- Published
- 2005
- Full Text
- View/download PDF
39. Cefazolin therapy for Staphylococcus aureus bacteremia.
- Author
-
Fernández-Guerrero ML and de Górgolas M
- Subjects
- Aged, Bacteremia microbiology, Endocarditis, Bacterial microbiology, Humans, Male, Staphylococcal Infections drug therapy, Staphylococcal Infections microbiology, Treatment Failure, Anti-Bacterial Agents therapeutic use, Bacteremia drug therapy, Cefazolin therapeutic use, Endocarditis, Bacterial drug therapy, Staphylococcus aureus drug effects
- Published
- 2005
- Full Text
- View/download PDF
40. [Central nervous system infections in HIV patients in the era of high activity antiretroviral treatment].
- Author
-
Rivas González P and Fernández Guerrero ML
- Subjects
- Central Nervous System Infections cerebrospinal fluid, Cytomegalovirus Infections epidemiology, Cytomegalovirus Infections microbiology, HIV Infections cerebrospinal fluid, HIV Infections immunology, Humans, Immunoglobulin G cerebrospinal fluid, Immunoglobulin G immunology, Leukoencephalopathy, Progressive Multifocal epidemiology, Leukoencephalopathy, Progressive Multifocal microbiology, Meningitis, Cryptococcal epidemiology, Meningitis, Cryptococcal microbiology, Toxoplasmosis epidemiology, Toxoplasmosis microbiology, Tuberculosis epidemiology, Tuberculosis microbiology, Antiretroviral Therapy, Highly Active methods, Central Nervous System Infections epidemiology, Central Nervous System Infections microbiology, HIV Infections drug therapy, HIV Infections epidemiology
- Abstract
Although the incidence of most central nervous system infections in HIV+ patients has decreased after the introduction of the modern antiretroviral treatments, they are still a major cause of morbidity and mortality. New technologies in molecular biology and neuroradiology establish the diagnosis in many cases and have decreased the need for cerebral biopsy. Prognosis has improved substantially after the introduction of high activity antiretroviral treatment; more active treatments are needed, however, for infections as PML or citomegalovirus encephalitis because of their still unacceptably high mortality.
- Published
- 2005
- Full Text
- View/download PDF
41. [Brucellosis with multiple pulmonary nodules and optic neuritis].
- Author
-
Casquero A, Núñez-García A, Crespi L, and Fernández-Guerrero ML
- Subjects
- Brucellosis diagnosis, Brucellosis drug therapy, Doxycycline therapeutic use, Granuloma drug therapy, Granuloma microbiology, Humans, Lung Diseases drug therapy, Lung Diseases microbiology, Male, Middle Aged, Optic Neuritis drug therapy, Brucellosis complications, Granuloma etiology, Lung Diseases etiology, Optic Neuritis etiology
- Published
- 2005
- Full Text
- View/download PDF
42. Sternal tuberculosis after open heart surgery.
- Author
-
Rivas P, Górgolas M, Gimena B, Sousa J, and Fernández-Guerrero ML
- Subjects
- Aged, Female, Humans, Osteomyelitis diagnosis, Surgical Wound Infection diagnosis, Tuberculosis diagnosis, Coronary Artery Bypass adverse effects, Mycobacterium tuberculosis isolation & purification, Osteomyelitis microbiology, Sternum microbiology, Surgical Wound Infection microbiology, Tuberculosis microbiology
- Abstract
We present a 68-y-old female who had undergone aortocoronary bypass and developed Staphylococcus aureus sternal osteomyelitis. Despite prolonged therapy with different antibiotics and several local debridements and drainage, the wound remained open and suppurative. Only after sternectomy and wide excision of infected costal cartilage was the diagnosis of sternal tuberculosis made, 24 months later. This case illustrates the necessity of a high degree of suspicion to diagnose this very rare entity which coexists with more common causes of sternal osteomyelitis.
- Published
- 2005
- Full Text
- View/download PDF
43. Migratory thrombophlebitis and acute Q fever.
- Author
-
Fernández Guerrero ML, Rivas P, and García Delgado R
- Subjects
- Adult, Humans, Male, Q Fever physiopathology, Q Fever complications, Thrombophlebitis complications
- Published
- 2004
- Full Text
- View/download PDF
44. Visceral leishmaniasis in immunocompromised patients with and without AIDS: a comparison of clinical features and prognosis.
- Author
-
Fernández-Guerrero ML, Robles P, Rivas P, Mójer F, Muñíz G, and de Górgolas M
- Subjects
- Adolescent, Adult, Aged, Female, Humans, Leishmaniasis, Visceral complications, Leishmaniasis, Visceral mortality, Male, Medical Records, Middle Aged, Prognosis, Retrospective Studies, HIV Infections immunology, HIV Seronegativity immunology, Immunocompromised Host immunology, Leishmaniasis, Visceral physiopathology
- Abstract
Visceral leishmaniasis is basically a disease of healthy infants and adults. However, in the last decade an increasing number of cases of kala azar in immunocompromised patients have been reported with emphasis on atypical manifestations of the disease. During a period of 11 years, 20 immunocompromised patients with AIDS (12 patient), haematological neoplasia (3 patients), corticosteroid therapy (3 patients) or renal transplantation (2 patients) were studied by one or more of the authors. We did not find differences in the presentation of leishmaniasis between patient with or without AIDS and most patients had fever, enlargement of the liver and spleen, blood cytopenias and biochemical abnormalities. Serology was more frequently positive in HIV-negative than in HIV-positive patients (100% versus 63.6%; P=0.13). Bone marrow biopsy was diagnostic in 66% and 87% of patients with and without AIDS, respectively. Failure of anti-leishmanial therapy occurred in 6 of 19 patients treated (31.5%), and 3 patients with AIDS and another 3 without AIDS died during the first episode of leishmaniasis. Of 12 survivors, relapses occurred in five (41.6%). Only patients in whom immunosuppression was ameliorated by means of antiretroviral therapy or by reduction of corticosteroid and other immunosuppressive drugs did not relapse. Treatment of kala azar in immunocompromised host is in satisfactory and new drugs or strategies are urgently needed.
- Published
- 2004
- Full Text
- View/download PDF
45. The spectrum of cardiovascular infections due to Salmonella enterica: a review of clinical features and factors determining outcome.
- Author
-
Fernández Guerrero ML, Aguado JM, Arribas A, Lumbreras C, and de Gorgolas M
- Subjects
- Acquired Immunodeficiency Syndrome complications, Aged, Aged, 80 and over, Aneurysm, Infected complications, Humans, Male, Mediastinitis complications, Middle Aged, Mortality, Pericarditis complications, Prognosis, Retrospective Studies, Risk Factors, Aneurysm, Infected pathology, Cardiovascular Surgical Procedures adverse effects, Endocarditis, Bacterial etiology, Endocarditis, Bacterial pathology, Salmonella Infections etiology, Salmonella Infections pathology, Salmonella enterica pathogenicity
- Abstract
Cardiovascular infections due to Salmonella enterica are infrequently reported, so their clinical features, prognosis, and optimal treatment are not completely known. Mortality associated with aortitis and endocarditis caused by nontyphoidal Salmonella remains exceedingly high. In this review of cases of cardiovascular infections due to Salmonella enterica studied in 2 hospitals in Madrid, we tried to assess the clinical manifestations and the procedures leading to diagnosis in addition to treatment and outcome. To complete the spectrum of infections related to cardiovascular surgery, cases of postoperative mediastinitis, pericarditis, and infections associated with cardiac devices were also included.Twenty-three patients were reviewed: 11 had mycotic aneurysms; 7 had endocarditis; 2 had device-related infections; and 3 had pericarditis, mediastinitis, and infection of an arteriovenous fistula, respectively. The risk of endovascular infection in patients older than 60 years with bacteremia due to nontyphoidal Salmonella was 23%. Most patients with aortitis had risk factors for atherosclerosis, and 6 had preexisting atherosclerotic aortic aneurysms. All except 1 patient with endocarditis had underlying cardiac disorders. Acquired immunodeficiency disease (AIDS) was a major risk factor for salmonella bacteremia in 1 patient with aortitis and 1 with endocarditis. Fever, unremitting sepsis, "breakthrough" and relapsing bacteremia were the most common clinical findings. In addition, abdominal or thoracic pain and cardiac failure and pericarditis were common features in patients with aortitis and endocarditis respectively. Computed tomography (CT) scan, arteriography, and echocardiography were the main diagnostic tools. Mortality associated with mycotic aneurysms and endocarditis due to S. enterica was 45% and 28%, respectively. Thoracic aneurysms, rupture, and shock at the time of diagnosis were associated with increased mortality in patients with aortitis. In situ bypass grafting was successfully performed in most cases. After surgery, antimicrobial therapy was continued for 4-9 weeks. No relapses were observed after a mean follow-up of 64 months. Antimicrobial therapy alone or combined with valve replacement or excision of a ventricular aneurysm was successful treatment for most patients with salmonella endocarditis. Combined medical and surgical treatment was required for patients with mediastinitis and pericarditis, and patients with device-related infections needed removal of the complete device. Diagnosis of aortitis due to nontyphoidal Salmonella should be established as early as possible to reduce mortality. Patients older than 60 years who have positive blood cultures for Salmonella along with fever and back, abdominal, or chest pain should have an extensive workup for infective aortitis. Immediate bactericidal antimicrobial therapy should be started and a CT scan should be performed on an emergency basis. If a mycotic aneurysm is found, surgical resection should follow as soon as possible. Resection of the aneurysm with in situ bypass grafting is the procedure of choice. Postoperative antimicrobial therapy for 6-8 weeks seems enough to avoid relapses. Optimal treatment of patients with endocarditis occurring on ventricular aneurysms must include resection of the aneurysmal sac. Salmonella endocarditis can be successfully treated with antimicrobials alone. Valve replacement should be reserved for patients with cardiac failure or persisting sepsis, and for those who relapse after discontinuation of antimicrobial therapy.
- Published
- 2004
- Full Text
- View/download PDF
46. Prosthetic valve endocarditis due to Listeria monocytogenes. Report of two cases and reviews.
- Author
-
Fernández Guerrero ML, Rivas P, Rábago R, Núñez A, de Górgolas M, and Martinell J
- Subjects
- Aged, Anti-Bacterial Agents therapeutic use, Endocarditis, Bacterial complications, Endocarditis, Bacterial drug therapy, Follow-Up Studies, Heart Failure etiology, Heart Valve Diseases etiology, Heart Valve Prosthesis microbiology, Humans, Listeriosis complications, Listeriosis drug therapy, MEDLINE, Male, Prosthesis-Related Infections complications, Prosthesis-Related Infections drug therapy, Endocarditis, Bacterial microbiology, Heart Valve Prosthesis adverse effects, Listeria monocytogenes pathogenicity, Listeriosis microbiology, Prosthesis-Related Infections microbiology
- Abstract
Introduction: Endocarditis due to Listeria monocytogenes is a rare but serious disease often leading to valve dysfunction and heart failure. Two cases of listerial prosthetic valve endocarditis are reviewed along with 66 cases previously reported., Results: The mean age of patients with listerial endocarditis increased from 47.1 years in the decades from 1955-1984 to 65.5 years from 1985-2000. Chronic debilitating diseases, solid tumours and immunosuppression associated with organ transplantation, hematologic neoplasia or AIDS were found in 41.1% of cases. Listerial endocarditis was a vegetative and destructive process, with dehiscense of the prosthesis and occasionally, abscess formation, fistulization and pericarditis. Treatment with penicillin or ampicillin alone or combined with gentamicin was adequate therapy in most cases. Vancomycin together with gentamicin may be a reasonable alternative therapy., Conclusions: Despite problems associated with microbial persistence and relapses in other forms of human listeriosis, antimicrobial therapy alone may be a successful treatment for listerial endocarditis, including cases occurring on prosthetic valves. Valve replacement may be reserved for complicated cases with valve dehiscense, cardiac failure or myocardial abscess. Overall mortality was 35.3%, although most patients who died did so before 1985 and since then mortality has been significantly reduced to 12%.
- Published
- 2004
- Full Text
- View/download PDF
47. Cutaneous and medullar gnathostomiasis in travelers to Mexico and Thailand.
- Author
-
Górgolas Md, Santos-O'Connor F, Unzú AL, Fernández-Guerrero ML, Gárate T, Troyas Guarch RM, and Grobusch MP
- Subjects
- Adult, Albendazole therapeutic use, Animals, Anthelmintics therapeutic use, Female, Humans, Male, Mexico, Nervous System Diseases diagnosis, Skin Diseases, Parasitic diagnosis, Spain, Spirurida Infections diagnosis, Spirurida Infections drug therapy, Spirurida Infections microbiology, Thailand, Treatment Outcome, Gnathostoma isolation & purification, Nervous System Diseases etiology, Skin Diseases, Parasitic etiology, Spirurida Infections complications, Travel
- Abstract
Gnathostomiasis is a rare nematode disease acquired by travelers to endemic areas. The most common clinical presentations are cutaneous forms; however, neurologic involvement can also occur. We present two cases of gnathostomiasis, one of them with severe neurologic complications, in Spanish travelers to Thailand and Mexico, who consumed local food and became infected.
- Published
- 2003
- Full Text
- View/download PDF
48. Bacteremic pneumococcal infections in immunocompromised patients without AIDS: the impact of beta-lactam resistance on mortality.
- Author
-
Fernández Guerrero ML, Ramos JM, Marrero J, Cuenca M, Fernández Roblas R, and de Górgolas M
- Subjects
- Adolescent, Adult, Aged, Anti-Bacterial Agents pharmacology, Bacteremia complications, Bacteremia drug therapy, Bacteremia microbiology, Bacteremia mortality, Female, Humans, Male, Middle Aged, Opportunistic Infections complications, Opportunistic Infections microbiology, Pneumococcal Infections complications, Pneumococcal Infections microbiology, Retrospective Studies, Streptococcus pneumoniae drug effects, beta-Lactams, Anti-Bacterial Agents therapeutic use, Drug Resistance, Multiple, Bacterial, Immunocompromised Host, Opportunistic Infections drug therapy, Opportunistic Infections mortality, Pneumococcal Infections drug therapy, Pneumococcal Infections mortality
- Abstract
Background: Streptococcus pneumoniae is the leading cause of community-acquired pneumonia in the elderly, and in recent years it has arisen as an important pathogen in HIV-infected patients. However, there is a scarcity of information on clinical and therapeutic problems associated with pneumococcal infections in other immuno-compromised patients. The objective of this study was to assess the most relevant epidemiologic aspects, clinical features and prognostic factors of pneumococcal bacteremia in immunocompromised hosts without AIDS., Methods: This was a retrospective analysis of patients with pneumococcemia, carried out in a 600-bed, university-affiliated hospital in Madrid, Spain. Two-hundred and sixty patients were evaluated retrospectively; 69 (26.5%) immunocompromised patients based on strict case definitions were compared with a group composed of 191 non-immunocompromised hosts with a variety of chronic conditions. Conventional management of pneumococcal bacteremia according to clinical standards was assessed. The MICs of penicillin and other beta-lactam antibiotics, and related mortality and hospital mortality at 30 days, were measured., Results: A comparison of clinical manifestations of pneumococcemia between immunocompromised patients and non-immunocompromised patients did not show differences in the presence of fever, obtundation, type of lung involvement, frequency of primary bacteremia, or meningitis. Hospital-acquired pneumococcemia was significantly more frequent in immunocompromised patients (34.7% versus 6.8%, P<0.0001), and resistance to penicillin was also more common in pneumococcal strains isolated from these patients (37.5% versus 20%, P=0.0009). Septic shock occurred more frequently in immunocompromised patients, although the overall and related mortality were not significantly different from those found in non-immunocompromised patients (33.3% versus 22.5%, P=0.07, and 28.9% versus 20.9%, P=0.7 respectively). In the multivariate analysis, multilobar pneumonia (odds ratio (OR) 15.7; 95% CI 6.00-41.30; P<0.001), inadequate treatment (OR 12.20; 95% CI 4.10-37.20; P<0.001), obtundation (OR 5.80; 95% CI 2.20-15.00; P<0.001) and hospital-acquired bacteremia (OR 4.80; 95% CI 1.00-14.60; P<0.006) were associated with an increased risk of mortality in patients with pneumococcemia. Only multilobar pneumonia (OR 7.90; 95% CI 4.10-15.35; P<0.001) was significantly associated with an increased risk of mortality in immunocompromised patients. Patients with acute leukemia and lymphoma had a greater mortality rate than non-immunocompromised patients (53.8% related mortality, P=0.05). Analysis of these patients showed frequent inadequate empirical therapy with ceftazidime plus amikacin in the presence of beta-lactam resistance., Conclusions: Much of the burden of pneumococcal bacteremia was attributable to immunosuppressive diseases. In immunocompromised patients, pneumococcemia was frequently acquired within the hospital during the treatment of the underlying condition, and resistance to penicillin was common. Patients with acute leukemia and lymphoma who develop fever and pneumonia should be treated with drugs active against beta-lactam-resistant pneumococci, irrespective of the setting in which the infection develops.
- Published
- 2003
- Full Text
- View/download PDF
49. Nosocomial enterococcal endocarditis: a serious hazard for hospitalized patients with enterococcal bacteraemia.
- Author
-
Fernández-Guerrero ML, Herrero L, Bellver M, Gadea I, Roblas RF, and de Górgolas M
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Heart Valve Diseases microbiology, Humans, Male, Middle Aged, Prospective Studies, Regression Analysis, Risk Factors, Bacteremia etiology, Cross Infection microbiology, Endocarditis, Bacterial microbiology, Enterococcus faecalis, Gram-Positive Bacterial Infections microbiology
- Abstract
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.
- Published
- 2002
- Full Text
- View/download PDF
50. [Recurrent fever as presenting from of colon carcinoma].
- Author
-
Fernández Guerrero ML, Jiménez Rodríguez A, de Julián Jiménez A, de Górgolas Hernández-Mora M, and González Cajigal R
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Recurrence, Colonic Neoplasms complications, Fever of Unknown Origin etiology
- Abstract
Fever of unknown origin (FUO) has been rarely associated with colonic cancer. In less than 1% of cases of FUO a colonic cancer is found as the main cause of fever. The authors reviewed 4 cases of colonic cancer whose first manifestation was FUO. Recurrent episodes of brief, self-limited fever, without a characteristic pattern, may be the first symptom of colonic cancer. On occassions, E. coli bacteremia may be the herald of an occult colonic malignancy.
- Published
- 2002
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.