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P0731 RETROSPECTIVE STUDY OF HIV INFECTED PATIENTS WITH SEVERE CHRONIC DISEASE
S238
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
Abstract P0729 – Table 1 Case 1 2 3
Sex / Age / Nationality
Stage AIDS
Debut AIDS
Viral charge
CD4
Associated comorbility
Treatment offered
Follow up
Male / 36 / Cuba Male / 28 / Senegal Male / 33 / Spain
C3 C3 C3
Yes Yes No
17600 85900 94800
177 168 104
None Castleman’s desease Hepatitis C
Doxorrubicin HAART Doxorrubicin HAART No treated
Favorable Favorable Unknown
multiple red and purple skin plaques, nodes and tumors in skin and other organs. It has three clinical forms: classic, endemic (African form) and epidemic, associated with HIV. In HIV, these lesions appear in head and thorax but can be found in other organs. Ocular location is very unusual in Kaposi’s sarcoma. The treatment includes antiretroviral therapy (HAART), chemotherapy (liposomal doxorubicin or daunorubicin) and more uncommonly surgery, radiotherapy or criotherapy. Objectives: We described the main clinical characteristics, treatment offered and follow up of three patients looked after in our hospital Materials & methods: We had made a review of all patients diagnosed of ocular Kaposi and HIV infection in our hospital. We present their main clinical features, its treatment offered and follow up. Results: See table above.
cated AP was defined in 62.3%. Previous empiric antibiotherapy was offered to 14.8%. Mean hospital stay was 7.01 days. Microbiological result was positive in 57% (45.9% urocultive, 20.7% blood cultures and both in 38.7%). Blood cultures were more frequent positive in complicated AP (53.7% Vs 36.4%). Positive blood cultures suppose no change in management or treatment in our patients, but hospital stay in these patients were longer (15.2 Vs 3.1, p<0.024). E-coli was the most frequent pathogen isolated in blood cultures (20%) and urocultives (42.4%). Discussion & conclusion: The profile of our AP patients is quite similar of there in literature. The most prevalent risk factors had been previous AP, urinary bladder catheterization and obstructive uropathy. Our microbiological results were agree with previous literature, being E-coli the pathogen most frequently isolated. In our series, blood cultures extraction supposed no difference in the management or treatment of AP. However, positive blood cultures seem to be related to a longer hospital stay and higher level of complications.
P0731 RETROSPECTIVE STUDY OF HIV INFECTED PATIENTS WITH SEVERE CHRONIC DISEASE
Gema Esteban Gutierrez, Laura Bragado Martinez, Laura Espinel Costoso, Alberto Arranz Caso, Fuensanta Moreno Barrio, Jose Sanz Moreno. Hospital Universitario Principe De Asturias
Discussion & conclusion: Ocular Kaposi is an unusual location for Kaposi’s disease. Usually is associated with an advanced form of HIV infection, with low CD4 counts and elevated viral charge as were in these cases. But usually the response to doxorubicin and HAART is favourable. This was the case in our two first patients, with complete disappearance of ocular lesions.
P0730 “USEFULNESS OF BLOOD CULTURES IN THE HOSPITALARY MANAGEMENT OF ACUTE PYELONEPHRYTIS”
Jorge Peris, Philip Wikman, María Gracia, Pedro Esteve, Sara Bañón, Jaqueline Robert, Ruth Cañizares, Jaime Merino. Servicio De Medicina Interna. Hospital San Juan (alicante) Introduction: Acute Pyelonephrytis (AP) comes over 250000 hospitalizations per year in the USA, with an incidence of 36 cases/10000/year, being higher in women. The main pathogen involved is E-coli, followed by Kleibsella sp, Serratia sp, Pseudomona aeroginosa and Staphylococcus saprophiticus. Blood and urine tests and urocultive are very useful to suggest the diagnosis. Blood cultures are often obtained in patients who have been admitted for the treatment of AP. Objectives: In this work we tried to define the differences in management of AP between patients with positive blood cultures and them with negatives. At the same time we pretended to discover the most relevant clinical findings in these patients Materials & methods: Retrospective study on 91 clinical reports of patients with AP recovered in our hospital, older than 16 years, during a year period. We have collected microbiological data, risk factors for the disease and treatment offered. The collected data were managed using SPSS 10 program, and stadistical analysis was χ2 for stadistical differences for value p<0.005. Results: For the analysis we included only patients with blood cultures obtained, so we excluded 30 cases. We have studied 61 cases. Of them 73.8% were women. Mean age was 50.11 years and 7.8% were pregnants. The risk factors found were: previous AP (17.2%), urinary bladder catheterization (9.8%), obstructive uropathy (24.6%), urological surgery (10.3%). Compli-
Introduction: HIV nephropathy (HIVAN) is the most frequent cause of severe chronic renal failure in HIV-infected black patients. However, the prevalence of other glomerulopathies has increased in the last years. Objetives: To analyze epidemiological, clinical and analytical data as well as renal biopsy (RB) findings in patients with HIV infection and severe chronic kidney disease in our hospital. Methods: Retrospective study of clinical reports during the period 1998-2008. Results: Our hospital infectious disease unit follows a medium of 750 HIV, from which 13 patients had severe renal failure (1.7%). The mean age at the nephropathy diagnosis was 42,1 years (25-62), with a higher prevalence in male (69%). 4 patients were black. 7 patients (53,8%) had been parenteral drug consumers and 6 (46,1%) were sexually infected. 53% of patients were hepatitis C virus (HCV) coinfected. 10 patients had hypertension, with effective treatment (ACE inhibitor and angiotensin receptor blocker) and 4 had diabetes (3 cases both of them). At the time of diagnosis, 4 patients had no HIV viral load evidence. There were 6 patients under 200 CD4 cells/μL, 6 between 200-500 cells/μL and 1 over 500 cells/μL. 46% of them had not been treated previously with antiretroviral therapy. All patients developed proteinuria; most of them (86%) had heavy proteinuria (4,7-17 g/24 hours) associated to nephrotic syndrome in 61%. In 5 patients the diagnosis of HIV infection was performed as the nephropathy was studied. RB was made in 10 patients with the following findings: non-collapsing focal segmental glomerulosclerosis (FSGS) (3), membranoproliferative glomerulonephritis (MPGN) (3), collapsing glomerulosclerosis (HIVAN) (1), mesangial glomerulonephritis (MGN) (1), mesangial glomerulonephritis and acute interstitial nephritis (1), minimal changes nephropathy (1). 3 patients were not biopsied (1 had diabetes, 1 had HCV coinfection and the other one both diseases). RB findings in HCV coinfected patients were: MPGN (3) and MGN (2). 7 patients were included in dialysis (4 died after medium 11 months). Of 6 not dialyzed patients, 2 died (average survival of 11 months) and 4 had a stable renal function during the follow-up. The first cause of death was infectious. Conclusions: The most frequent cause of severe chronic kidney disease among our HIV-infected patients are glomerular diseases different from HIVAN, both in black and non-black individuals. At diagnosis almost all patients had severe inmunosupresion. It is frequent the association of other renal disease risk factors as hypertension, diabetes or HCV coinfection. Because of these reasons, renal biopsy is still playing a main role in these patients diagnosis. Keywords: HIV infection. HIV nephropathy.Glomerular disease.
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
Abstract P0729 – Table 1 Case 1 2 3
Sex / Age / Nationality
Stage AIDS
Debut AIDS
Viral charge
CD4
Associated comorbility
Treatment offered
Follow up
Male / 36 / Cuba Male / 28 / Senegal Male / 33 / Spain
C3 C3 C3
Yes Yes No
17600 85900 94800
177 168 104
None Castleman’s desease Hepatitis C
Doxorrubicin HAART Doxorrubicin HAART No treated
Favorable Favorable Unknown
multiple red and purple skin plaques, nodes and tumors in skin and other organs. It has three clinical forms: classic, endemic (African form) and epidemic, associated with HIV. In HIV, these lesions appear in head and thorax but can be found in other organs. Ocular location is very unusual in Kaposi’s sarcoma. The treatment includes antiretroviral therapy (HAART), chemotherapy (liposomal doxorubicin or daunorubicin) and more uncommonly surgery, radiotherapy or criotherapy. Objectives: We described the main clinical characteristics, treatment offered and follow up of three patients looked after in our hospital Materials & methods: We had made a review of all patients diagnosed of ocular Kaposi and HIV infection in our hospital. We present their main clinical features, its treatment offered and follow up. Results: See table above.
cated AP was defined in 62.3%. Previous empiric antibiotherapy was offered to 14.8%. Mean hospital stay was 7.01 days. Microbiological result was positive in 57% (45.9% urocultive, 20.7% blood cultures and both in 38.7%). Blood cultures were more frequent positive in complicated AP (53.7% Vs 36.4%). Positive blood cultures suppose no change in management or treatment in our patients, but hospital stay in these patients were longer (15.2 Vs 3.1, p<0.024). E-coli was the most frequent pathogen isolated in blood cultures (20%) and urocultives (42.4%). Discussion & conclusion: The profile of our AP patients is quite similar of there in literature. The most prevalent risk factors had been previous AP, urinary bladder catheterization and obstructive uropathy. Our microbiological results were agree with previous literature, being E-coli the pathogen most frequently isolated. In our series, blood cultures extraction supposed no difference in the management or treatment of AP. However, positive blood cultures seem to be related to a longer hospital stay and higher level of complications.
P0731 RETROSPECTIVE STUDY OF HIV INFECTED PATIENTS WITH SEVERE CHRONIC DISEASE
Gema Esteban Gutierrez, Laura Bragado Martinez, Laura Espinel Costoso, Alberto Arranz Caso, Fuensanta Moreno Barrio, Jose Sanz Moreno. Hospital Universitario Principe De Asturias
Discussion & conclusion: Ocular Kaposi is an unusual location for Kaposi’s disease. Usually is associated with an advanced form of HIV infection, with low CD4 counts and elevated viral charge as were in these cases. But usually the response to doxorubicin and HAART is favourable. This was the case in our two first patients, with complete disappearance of ocular lesions.
P0730 “USEFULNESS OF BLOOD CULTURES IN THE HOSPITALARY MANAGEMENT OF ACUTE PYELONEPHRYTIS”
Jorge Peris, Philip Wikman, María Gracia, Pedro Esteve, Sara Bañón, Jaqueline Robert, Ruth Cañizares, Jaime Merino. Servicio De Medicina Interna. Hospital San Juan (alicante) Introduction: Acute Pyelonephrytis (AP) comes over 250000 hospitalizations per year in the USA, with an incidence of 36 cases/10000/year, being higher in women. The main pathogen involved is E-coli, followed by Kleibsella sp, Serratia sp, Pseudomona aeroginosa and Staphylococcus saprophiticus. Blood and urine tests and urocultive are very useful to suggest the diagnosis. Blood cultures are often obtained in patients who have been admitted for the treatment of AP. Objectives: In this work we tried to define the differences in management of AP between patients with positive blood cultures and them with negatives. At the same time we pretended to discover the most relevant clinical findings in these patients Materials & methods: Retrospective study on 91 clinical reports of patients with AP recovered in our hospital, older than 16 years, during a year period. We have collected microbiological data, risk factors for the disease and treatment offered. The collected data were managed using SPSS 10 program, and stadistical analysis was χ2 for stadistical differences for value p<0.005. Results: For the analysis we included only patients with blood cultures obtained, so we excluded 30 cases. We have studied 61 cases. Of them 73.8% were women. Mean age was 50.11 years and 7.8% were pregnants. The risk factors found were: previous AP (17.2%), urinary bladder catheterization (9.8%), obstructive uropathy (24.6%), urological surgery (10.3%). Compli-
Introduction: HIV nephropathy (HIVAN) is the most frequent cause of severe chronic renal failure in HIV-infected black patients. However, the prevalence of other glomerulopathies has increased in the last years. Objetives: To analyze epidemiological, clinical and analytical data as well as renal biopsy (RB) findings in patients with HIV infection and severe chronic kidney disease in our hospital. Methods: Retrospective study of clinical reports during the period 1998-2008. Results: Our hospital infectious disease unit follows a medium of 750 HIV, from which 13 patients had severe renal failure (1.7%). The mean age at the nephropathy diagnosis was 42,1 years (25-62), with a higher prevalence in male (69%). 4 patients were black. 7 patients (53,8%) had been parenteral drug consumers and 6 (46,1%) were sexually infected. 53% of patients were hepatitis C virus (HCV) coinfected. 10 patients had hypertension, with effective treatment (ACE inhibitor and angiotensin receptor blocker) and 4 had diabetes (3 cases both of them). At the time of diagnosis, 4 patients had no HIV viral load evidence. There were 6 patients under 200 CD4 cells/μL, 6 between 200-500 cells/μL and 1 over 500 cells/μL. 46% of them had not been treated previously with antiretroviral therapy. All patients developed proteinuria; most of them (86%) had heavy proteinuria (4,7-17 g/24 hours) associated to nephrotic syndrome in 61%. In 5 patients the diagnosis of HIV infection was performed as the nephropathy was studied. RB was made in 10 patients with the following findings: non-collapsing focal segmental glomerulosclerosis (FSGS) (3), membranoproliferative glomerulonephritis (MPGN) (3), collapsing glomerulosclerosis (HIVAN) (1), mesangial glomerulonephritis (MGN) (1), mesangial glomerulonephritis and acute interstitial nephritis (1), minimal changes nephropathy (1). 3 patients were not biopsied (1 had diabetes, 1 had HCV coinfection and the other one both diseases). RB findings in HCV coinfected patients were: MPGN (3) and MGN (2). 7 patients were included in dialysis (4 died after medium 11 months). Of 6 not dialyzed patients, 2 died (average survival of 11 months) and 4 had a stable renal function during the follow-up. The first cause of death was infectious. Conclusions: The most frequent cause of severe chronic kidney disease among our HIV-infected patients are glomerular diseases different from HIVAN, both in black and non-black individuals. At diagnosis almost all patients had severe inmunosupresion. It is frequent the association of other renal disease risk factors as hypertension, diabetes or HCV coinfection. Because of these reasons, renal biopsy is still playing a main role in these patients diagnosis. Keywords: HIV infection. HIV nephropathy.Glomerular disease.