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P0693 PRIMARY HIV INFECTION
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
S227
P0693
P0695
PRIMARY HIV INFECTION
URINARY TRACT INFECTIONS: THE MICROBIOLOGICAL POPULATION OF AN INTERNAL MEDICINE DEPARTMENT AND THE EVOLUTION OF RESISTANCE TO ANTIBIOTICS OVER A 5 YEAR PERIOD
Teresa Blanco, Blanca Pinilla, Susana Gordo, Jose Manuel Hens, Jose Luis Fraile, Maria Gomez, Javier Cabrera, Cristina López, Antonio Muiño. Hgu Gregorio Marañón Introduction: Primary HIV-infection can present as mononucleosis type of syndrome.Without a high index of suspicion the diagnosis of prymary HIV –infection can frequently be missed. Establishing the diagnosis of primary HIV infection is clearly important from the public health perspective as patiens are highly infectius during acute HIV due to an enormous viral burden in blood an genital secretions. Objectives: We present a pacient with a mononucleosis type sindrome and prymary HIV infection. Results: A 52-year-old female with past medical history significant for mastectomy due to ductal hyperplasia and ulcer disease asociated with h. Pylori infection alredy treated.came to the emergeny room with a history of 15th days of fever in the range of 38 to 39°C. She also had clinical manifestation of two days lasting acute watery diarrhea with pain in right hypocondrium. She also had a generalized macular rash not pruriginus respectin palms and soles.Physical examination revealed no abnormality. Laboratory test revealed elevation in liver enzimes,in the begining there was a fall in the total white blood cell count thereafter there was an expansion of lymphocites. Differential diagnosis of acute VIH infection includes mononuclesosis due to Epstein Barr, Cytomegalivirus, Toxoplasmosis, Rubeola, viral hepatitis and other viral infections. Monospot test for infectious mononucleosis was negative in our pacient and also IgM and IgG against EBV. IgM antibodies to CMV were negatives as well as HBsAg, anti-HBc,Ac- HCV.We obtain an HIV viral load test and serologic test which led to the diagnosis of of primary HIV infection in a 52-year-old female with mononucleosis like syndrome. Discussion & conclusion: The diagnosis of acutte HIV infection is infrequently made in clinical practice.A variety of symptoms and signs may be seen in association with acute HIV infection.Primary HIV infection causes a febrille illness resembling mononucleosis. Patients who present with a heterophile negative mononucleosis like syndrome should have quantitative plasma HIV RNA and HIV antibody testing to rule out primary HIV infection since early diagnosis is important for patient management and to decrase the risk of transmission to others. The diagnosis of HIV infection is established by demonstrating a high viral load or a positive p24 antigen and a negative or indeterminated HIV serologic test.
Vitor Fagundes, Andre Pauperio, Iva Guimarães, João Pinto, Anabela Silva, Graça Ferraz. Centro Hospitalar Do Tâmega E Sousa, Epe - Penafiel Portugal Introduction: The increase of resistance to antibiotics, shown in recent studies, is one of the biggest challenges of the medical community. The knowledge of local realities plays an important role in this challenge by allowing to define strategies to reduce this trend. Objectives: The authors proposed to analyze the microbiological population of an Internal Medicine Department and describe the evolution of the resistance to antibiotics over a 5 year period at a hospital in the north of Portugal with a population area of 500.000. Material/methods: A retrospective study made between the 1st January of 2004 and the 31st November of 2008. It included all samples sent to the laboratory from the Internal Medicine Department with a positive urine culture. The analyses focused on the number of cases per bacterial agent and the description of the resistance to antibiotics evolution. Results: There were 1370 samples included. The most frequently isolated agent was Escherichia coli with 530 cases (37.4%). Then it was Candida albicans with 175 cases (12.8%), Klebsiella pneumoniae 159 (11%), Enterococcus faecalis 138 (10%) and Pseudomonas aeruginosa 127 (9.2%). Among the most frequent agents, all presented a homogeneous distribution during the study, except the Pseudomonas aeruginosa that presented a higher predominance in the final 2 years, keeping the same resistance profile for carbapenemes and piperacilin-tazobactam, with increasing resistance to fluoroquinolone antibiotics. With the Escherichia coli the authors observed a global rise in the number of cases of resistance to antibiotics, keeping a 100% sensibility to carbapenemes. Still among the most common agents it is remarked, for the Enterococcus faecalis the increasing number of agents resistant to vancomycin. Discussion & conclusion: The trend in the rise of antibiotic resistance was relevant in most agents, which confirms the evidences shown in recent publications. Keywords: urinary tract infections, antibiotics resistance, Escherichia coli, Candida albicans, Klebsiella pneumoniae, Enterococcus faecalis, Pseudomonas aeruginosa.
P0694 NEUROCYSTICERCOSIS
Sheila Ferreira, Miriam Magalhães, Ana Araújo, Clara Brito, Amalia Pereira, Morna Gonçalves. Hospital Santo Andre, E.p.e., Leiria Neurocysticercosis is a disease that may occur after hatching and dissemination of Taema solium larvae in the Central Nervous System The host reaction determines the evolution of the disease. Many times the cysticerci last indefinitely possibly developing inflammatory nodules which may disappear or become calcified. Clinically the patients may present with headaches, seizures, intra-cranial hypertension, focal or diffuse neurological signs. Computed tomography (CT) and magnetic resonance imaging (MRI) usually make the diagnosis. The authors present a case of an 80 year-old female admitted at the Internal Medicine department in 2008 presenting with ataxia, dizziness and syncope. Brain CT disclosed an acute right temporal lobe subdural hematoma associated to a lesion suggestive of neoplastic/infectious ethiology. Blood analysis showed leukocytosis with 89% neutrophils; erythrocyte sedimentation rate of 89 mm; normal renal and hepatic parameters; non elevated tumour markers. The MRI demonstrated a small expansive multiloculated lesion measuring 2,8 x 3,4 cm consisting of an aggregate of multiple small thin-walled cysts, compatible with the diagnosis of neurocysticercosis. Treatment was started with albendazole and dexamethasone, obtaining significant clinical improvement. Currently the patient is asymptomatic and a second MRI visualizes brain cysts although mass effect is not detected.
P0696 MRSA AORTITIS, ENDOCARDITIS AND OSTHEOMYELITIS
Jorge A Ruivo, Ana Tornada, Paula Alcantara. Hospital Santa Maria Mehtycilin-resistant Staphylococcus aureus (MRSA) is responsible for 30% of all in-hospital infections. Colonization risk factors include prolonged hospital stay, previous antibiotherapy, admittance in an intensive care unit, hemodialysis and proximity with MRSA contaminated patients. The progression from colonization to infection relates to invasive procedures. We describe the case of a 66 year old caucasian male, admitted through the emergency department, with a type B aortic dissection (extending from the left subclavian artery to the iliac ramification). Since there were no emergent criteria for surgery present, a conservative anti-hypertensive strategy was put into action. On his 3rd admittance week in the Vascular Surgery ward, he developed fever and lower limb petechiae, following infection of the radial artery puncture site. By this time MRSA was identified on blood cultures. He then was transferred to the Infectious Disease ward with the diagnosis of MRSA endocarditis, complicated by leucocytoclastic vasculitis. The infection evolved and later a D12-S1 spondilytis and a sacral ostheomyelitis ensued. On the 26th antibiotic coverage day, rifampicin and doxyciclin were added because of persistent positive blood cultures. On the 46th antibiotic coverage day, we underwent a whole body PET scan which revealed a small thoracic aorta hyperfixation signal, suggestive of infectious endarthritis. He died of sudden death on the following dawn. Vancomycin is the antibiotic gold-standart therapy to fight MRSA bacteremia. Despite this fact, in vitro antibiotic sensibility not always correlates well with in vivo results, namely in patients with severe infection in multiple secondary focci. In such cases, the addition of gentamycin, linezolide, daptomycin, doxyciclin and/or rifampicin should be considered. The mortality rate among MRSA bacteremic patients, the diminishing number of efficacious antibiotics, and the growing bacterial resistances, underlines the importance of a prompt management of possible infection sites, and an entailing aggressive treatment.
S227
P0693
P0695
PRIMARY HIV INFECTION
URINARY TRACT INFECTIONS: THE MICROBIOLOGICAL POPULATION OF AN INTERNAL MEDICINE DEPARTMENT AND THE EVOLUTION OF RESISTANCE TO ANTIBIOTICS OVER A 5 YEAR PERIOD
Teresa Blanco, Blanca Pinilla, Susana Gordo, Jose Manuel Hens, Jose Luis Fraile, Maria Gomez, Javier Cabrera, Cristina López, Antonio Muiño. Hgu Gregorio Marañón Introduction: Primary HIV-infection can present as mononucleosis type of syndrome.Without a high index of suspicion the diagnosis of prymary HIV –infection can frequently be missed. Establishing the diagnosis of primary HIV infection is clearly important from the public health perspective as patiens are highly infectius during acute HIV due to an enormous viral burden in blood an genital secretions. Objectives: We present a pacient with a mononucleosis type sindrome and prymary HIV infection. Results: A 52-year-old female with past medical history significant for mastectomy due to ductal hyperplasia and ulcer disease asociated with h. Pylori infection alredy treated.came to the emergeny room with a history of 15th days of fever in the range of 38 to 39°C. She also had clinical manifestation of two days lasting acute watery diarrhea with pain in right hypocondrium. She also had a generalized macular rash not pruriginus respectin palms and soles.Physical examination revealed no abnormality. Laboratory test revealed elevation in liver enzimes,in the begining there was a fall in the total white blood cell count thereafter there was an expansion of lymphocites. Differential diagnosis of acute VIH infection includes mononuclesosis due to Epstein Barr, Cytomegalivirus, Toxoplasmosis, Rubeola, viral hepatitis and other viral infections. Monospot test for infectious mononucleosis was negative in our pacient and also IgM and IgG against EBV. IgM antibodies to CMV were negatives as well as HBsAg, anti-HBc,Ac- HCV.We obtain an HIV viral load test and serologic test which led to the diagnosis of of primary HIV infection in a 52-year-old female with mononucleosis like syndrome. Discussion & conclusion: The diagnosis of acutte HIV infection is infrequently made in clinical practice.A variety of symptoms and signs may be seen in association with acute HIV infection.Primary HIV infection causes a febrille illness resembling mononucleosis. Patients who present with a heterophile negative mononucleosis like syndrome should have quantitative plasma HIV RNA and HIV antibody testing to rule out primary HIV infection since early diagnosis is important for patient management and to decrase the risk of transmission to others. The diagnosis of HIV infection is established by demonstrating a high viral load or a positive p24 antigen and a negative or indeterminated HIV serologic test.
Vitor Fagundes, Andre Pauperio, Iva Guimarães, João Pinto, Anabela Silva, Graça Ferraz. Centro Hospitalar Do Tâmega E Sousa, Epe - Penafiel Portugal Introduction: The increase of resistance to antibiotics, shown in recent studies, is one of the biggest challenges of the medical community. The knowledge of local realities plays an important role in this challenge by allowing to define strategies to reduce this trend. Objectives: The authors proposed to analyze the microbiological population of an Internal Medicine Department and describe the evolution of the resistance to antibiotics over a 5 year period at a hospital in the north of Portugal with a population area of 500.000. Material/methods: A retrospective study made between the 1st January of 2004 and the 31st November of 2008. It included all samples sent to the laboratory from the Internal Medicine Department with a positive urine culture. The analyses focused on the number of cases per bacterial agent and the description of the resistance to antibiotics evolution. Results: There were 1370 samples included. The most frequently isolated agent was Escherichia coli with 530 cases (37.4%). Then it was Candida albicans with 175 cases (12.8%), Klebsiella pneumoniae 159 (11%), Enterococcus faecalis 138 (10%) and Pseudomonas aeruginosa 127 (9.2%). Among the most frequent agents, all presented a homogeneous distribution during the study, except the Pseudomonas aeruginosa that presented a higher predominance in the final 2 years, keeping the same resistance profile for carbapenemes and piperacilin-tazobactam, with increasing resistance to fluoroquinolone antibiotics. With the Escherichia coli the authors observed a global rise in the number of cases of resistance to antibiotics, keeping a 100% sensibility to carbapenemes. Still among the most common agents it is remarked, for the Enterococcus faecalis the increasing number of agents resistant to vancomycin. Discussion & conclusion: The trend in the rise of antibiotic resistance was relevant in most agents, which confirms the evidences shown in recent publications. Keywords: urinary tract infections, antibiotics resistance, Escherichia coli, Candida albicans, Klebsiella pneumoniae, Enterococcus faecalis, Pseudomonas aeruginosa.
P0694 NEUROCYSTICERCOSIS
Sheila Ferreira, Miriam Magalhães, Ana Araújo, Clara Brito, Amalia Pereira, Morna Gonçalves. Hospital Santo Andre, E.p.e., Leiria Neurocysticercosis is a disease that may occur after hatching and dissemination of Taema solium larvae in the Central Nervous System The host reaction determines the evolution of the disease. Many times the cysticerci last indefinitely possibly developing inflammatory nodules which may disappear or become calcified. Clinically the patients may present with headaches, seizures, intra-cranial hypertension, focal or diffuse neurological signs. Computed tomography (CT) and magnetic resonance imaging (MRI) usually make the diagnosis. The authors present a case of an 80 year-old female admitted at the Internal Medicine department in 2008 presenting with ataxia, dizziness and syncope. Brain CT disclosed an acute right temporal lobe subdural hematoma associated to a lesion suggestive of neoplastic/infectious ethiology. Blood analysis showed leukocytosis with 89% neutrophils; erythrocyte sedimentation rate of 89 mm; normal renal and hepatic parameters; non elevated tumour markers. The MRI demonstrated a small expansive multiloculated lesion measuring 2,8 x 3,4 cm consisting of an aggregate of multiple small thin-walled cysts, compatible with the diagnosis of neurocysticercosis. Treatment was started with albendazole and dexamethasone, obtaining significant clinical improvement. Currently the patient is asymptomatic and a second MRI visualizes brain cysts although mass effect is not detected.
P0696 MRSA AORTITIS, ENDOCARDITIS AND OSTHEOMYELITIS
Jorge A Ruivo, Ana Tornada, Paula Alcantara. Hospital Santa Maria Mehtycilin-resistant Staphylococcus aureus (MRSA) is responsible for 30% of all in-hospital infections. Colonization risk factors include prolonged hospital stay, previous antibiotherapy, admittance in an intensive care unit, hemodialysis and proximity with MRSA contaminated patients. The progression from colonization to infection relates to invasive procedures. We describe the case of a 66 year old caucasian male, admitted through the emergency department, with a type B aortic dissection (extending from the left subclavian artery to the iliac ramification). Since there were no emergent criteria for surgery present, a conservative anti-hypertensive strategy was put into action. On his 3rd admittance week in the Vascular Surgery ward, he developed fever and lower limb petechiae, following infection of the radial artery puncture site. By this time MRSA was identified on blood cultures. He then was transferred to the Infectious Disease ward with the diagnosis of MRSA endocarditis, complicated by leucocytoclastic vasculitis. The infection evolved and later a D12-S1 spondilytis and a sacral ostheomyelitis ensued. On the 26th antibiotic coverage day, rifampicin and doxyciclin were added because of persistent positive blood cultures. On the 46th antibiotic coverage day, we underwent a whole body PET scan which revealed a small thoracic aorta hyperfixation signal, suggestive of infectious endarthritis. He died of sudden death on the following dawn. Vancomycin is the antibiotic gold-standart therapy to fight MRSA bacteremia. Despite this fact, in vitro antibiotic sensibility not always correlates well with in vivo results, namely in patients with severe infection in multiple secondary focci. In such cases, the addition of gentamycin, linezolide, daptomycin, doxyciclin and/or rifampicin should be considered. The mortality rate among MRSA bacteremic patients, the diminishing number of efficacious antibiotics, and the growing bacterial resistances, underlines the importance of a prompt management of possible infection sites, and an entailing aggressive treatment.