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P310 Fever in intravenous drug abuser patient
S118
Abstracts
I European
Journal
of Internal
ing and multiple retroperitoneal adenopathies. A gastroscopy was performed showing no alterations, and a duodenal biopsy showed atrophical vellosities and PAS positive material. Electron microscopy showed multiple trilaminar wall rods which are diagnostic of WD (showed on figures). After eighteen-month treatment with trimetropin/sulfametoxazol the patient was well, recovered weight, the abdominal alterations disappeared and there was no fever six months later.
P310 Fever in intravenous drug abuser patient S. Lopez-Tarruela, A.M. Garcia, M. Romero, (Madrid, E)
.I. Lobo,
B. Rojano,V
Rota
Context: Haemophilus parainfluenzae is an uncommon cause of endocarditis. Isolated reports of polimicrobial endocarditis in which H. Parainfluenzae was one of the pathogens have also been described, but a few of these cases have involved intravenous drug abusers. Design: We report a 26-year-old man, with acquired immunodeficiency syndrom (AIDS), who used intravenous heroin, and was febrile for more than a week prior to admission. Presented with myalgias, arthralgias, dispnea, a systolic and diastolic murmur and a elevated white blood cell count. Results: Chest radiography revealed diffuse infiltrated. Ecocardiography showed vegetations in aortic valve and in tricuspid valve, with valvular insufficiency. In blood culture H. Parainfluenzae was isolated on Days 14th and 16th. The treatment with antibiotic include ampicillin, but the patient didn’t respond and died because of the infection. Conclusions: Endocarditis with H. parainfluenzae in intravenous drug abusers is a distinct clinical syndrom and should be considered in all patients if the fever persist or if the response to appropriate antibiotic is atypical. Congestive heart failure is the most common serious complication of infective endocarditis and is the leading cause of death among patient with this infection.
P311 Infectious endocarditis in the old patient R. Caiiizares, J. Robert, P. Roig, E. Vicente, (Alicante, E)
F. Jover,
Medicine
I4 (2003)
SILT159
Conclusions: In old patients, IE usually appears with non-specific symptoms, so in patients older than 65, with fever as a unique manifestation, IE must be highly suspected. We emphasize the great variety of aetiologic agents, with a low incidence of usual microorganisms and the presence of other unusual ones (Salmonella enteritidis, Gemella morbillorum, Staphylococcus lugdunensis). Mortality was very low (12.5%) considering that other series outline a worse prognosis for IE in old patients.
P312 Psoas abscesses in HIV positive patients. Presentation of 5 cases R. Cariizares, P. Roig, J.M. Cuadrado, M. Rodriguez, F. Jover, J. Robert (Alicante, E) Introduction: Psoas abscess (PA) is an uncommon infectious disease, whose incidence has increased in the last years mostly in old and immunocompromised patients. Nevertheless, it is barely described in HIV positive patients. Methods: We retrospectively reviewed the cases of PA diagnosed in our hospital during the last 10 years. We analyzed their epidemiological and clinical features, their treatment and outcome. All our patients had an etiologic agent microbiologically isolated. Results: We found 5 PA cases in HIV positive patients. All were male, intravenous drug addicts, with an average age of 28. The PA origin was: primary in 4 cases and secondary to espondylodiscitis in 1. The symptoms were: protracted fever in all, back pain in 3 and abdominal pain in 2. Diagnosis was made by CT scan of the abdomen and needle aspiration of the abscess for microbiological study. Aetiologic agents were M. tuberculosis in 3 cases and S. aureus in 2. Treatment was: non-surgical percutaneous drainage in 3 cases, and surgical drainage in 2. Evolution was good in all. Conclusions: 1. PA is uncommom in HIV positive patients. 2. In our series primary PA prevails, unlike previous reports in Literature. 3. The most frequent microorganisms found are M tuberculosis and S. aureus, as opposed to other articles who describe mostly enterobacteriaceae. 4. Outcome is favorable, mostly with medical treatment and percutaneous drainage.
J. Montagud
Objective; To determine the microbiological and clinical features, complications and prognosis of the infectious endocarditis (IE) in the old patient. Methods: We conducted a retrospective study of the cases of IE diagnosed in our hospital from January 1992 to March 2003 in patients older than 65. Diagnosis was based on modified criteria of Duke. Results: We found to have IE in 16 patients older than 6.5, with an equal distribution by sexes. Average age was 74 (rank 65-89). In 6 cases (375%) a previous well-known valvulopaty existed, with IE on the injured valve. The affected valve was mitral in 12 cases (75%) and aortic in 4 (25%). The most frequent symptom was fever (in 100%) which lasted between 1 day and 6 months. 5 cases (31.25%) had symptoms that pointed to EI: 2 peripheral embolisms (at retinal artery and hand), 2 cerebrovascular ischemic attacks and 1 recent heart failure. Blood cultures were positive in 100% of the cases, with: 3 Staphylococcus aureus, 2 Gemella morbillorum, 2 Streptococcus constellatus, 2 Enterococcus faecalis, 1 Salmonella enteritidis, 1 Streptococcus viridans, 1 Streptococcus epidermidis, 1 Escherichia coli, 1 Streptococcus pneumoniae, 1 Staphylococcus lugdunensis and 1 gram-negative bacillus not identified. The initial empirical antibiotic coverage was modified according to microbiological results. 4 cases (25%) required heart surgery with replacement of the affected valve due to residual heart failure. Global mortality was of 2 cases (12.5%) due to heart failure. The Average length of hospitalization was 35.44 days.
P313 Resistence and epidemiological study of tuberculosis hospital J. Gonzalez-Castillo, M.A. Lozano, S. Muiioz, P. Cubo, Merino (Madrid, E)
in a Spanish R. Caminero,
P.
Background: Tuberculosis is still an important disease with elevate prevalence in our country, due to Human Immunodeficiency Virus (HIV) infection and immigration. In this study we analyse if there is a new clinic presentation and an increase of primary resistance in the last years. Methods: Retrospective study of clinical charts from all patients income in our Hospital between 2000-2002 with diagnosis of tuberculosis. Epidemiological variables, risk factors, symptoms, treatment and resistance test were assessed. Results: 108 patients with tuberculosis diagnosis were recorded (55% male). Mean age was 37 years. 53% of patients were born in Spain while 43% were inmigrants from South America (70% of foreign people). 68% of subjects had a predisponent cause to suffer tuberculosis HIV infection diagnosis were present in 43% of patients. The more frequent localitation was pulmonary and most common sympton was respiratory. Widespread treatment stablish was Isoniazid, Rifampin and Pirazinamida (89%). A regimen with 3 drugs was prescrib in 61% of subjects and 4 drugs in 36% of them. Primary resistence was observed to Isoniazid, Rifampin, Pyrazinamide and Ethambutol in 6.4%, 2%, 0.9% and 6% of cases respectively.
Abstracts
I European
Journal
of Internal
ing and multiple retroperitoneal adenopathies. A gastroscopy was performed showing no alterations, and a duodenal biopsy showed atrophical vellosities and PAS positive material. Electron microscopy showed multiple trilaminar wall rods which are diagnostic of WD (showed on figures). After eighteen-month treatment with trimetropin/sulfametoxazol the patient was well, recovered weight, the abdominal alterations disappeared and there was no fever six months later.
P310 Fever in intravenous drug abuser patient S. Lopez-Tarruela, A.M. Garcia, M. Romero, (Madrid, E)
.I. Lobo,
B. Rojano,V
Rota
Context: Haemophilus parainfluenzae is an uncommon cause of endocarditis. Isolated reports of polimicrobial endocarditis in which H. Parainfluenzae was one of the pathogens have also been described, but a few of these cases have involved intravenous drug abusers. Design: We report a 26-year-old man, with acquired immunodeficiency syndrom (AIDS), who used intravenous heroin, and was febrile for more than a week prior to admission. Presented with myalgias, arthralgias, dispnea, a systolic and diastolic murmur and a elevated white blood cell count. Results: Chest radiography revealed diffuse infiltrated. Ecocardiography showed vegetations in aortic valve and in tricuspid valve, with valvular insufficiency. In blood culture H. Parainfluenzae was isolated on Days 14th and 16th. The treatment with antibiotic include ampicillin, but the patient didn’t respond and died because of the infection. Conclusions: Endocarditis with H. parainfluenzae in intravenous drug abusers is a distinct clinical syndrom and should be considered in all patients if the fever persist or if the response to appropriate antibiotic is atypical. Congestive heart failure is the most common serious complication of infective endocarditis and is the leading cause of death among patient with this infection.
P311 Infectious endocarditis in the old patient R. Caiiizares, J. Robert, P. Roig, E. Vicente, (Alicante, E)
F. Jover,
Medicine
I4 (2003)
SILT159
Conclusions: In old patients, IE usually appears with non-specific symptoms, so in patients older than 65, with fever as a unique manifestation, IE must be highly suspected. We emphasize the great variety of aetiologic agents, with a low incidence of usual microorganisms and the presence of other unusual ones (Salmonella enteritidis, Gemella morbillorum, Staphylococcus lugdunensis). Mortality was very low (12.5%) considering that other series outline a worse prognosis for IE in old patients.
P312 Psoas abscesses in HIV positive patients. Presentation of 5 cases R. Cariizares, P. Roig, J.M. Cuadrado, M. Rodriguez, F. Jover, J. Robert (Alicante, E) Introduction: Psoas abscess (PA) is an uncommon infectious disease, whose incidence has increased in the last years mostly in old and immunocompromised patients. Nevertheless, it is barely described in HIV positive patients. Methods: We retrospectively reviewed the cases of PA diagnosed in our hospital during the last 10 years. We analyzed their epidemiological and clinical features, their treatment and outcome. All our patients had an etiologic agent microbiologically isolated. Results: We found 5 PA cases in HIV positive patients. All were male, intravenous drug addicts, with an average age of 28. The PA origin was: primary in 4 cases and secondary to espondylodiscitis in 1. The symptoms were: protracted fever in all, back pain in 3 and abdominal pain in 2. Diagnosis was made by CT scan of the abdomen and needle aspiration of the abscess for microbiological study. Aetiologic agents were M. tuberculosis in 3 cases and S. aureus in 2. Treatment was: non-surgical percutaneous drainage in 3 cases, and surgical drainage in 2. Evolution was good in all. Conclusions: 1. PA is uncommom in HIV positive patients. 2. In our series primary PA prevails, unlike previous reports in Literature. 3. The most frequent microorganisms found are M tuberculosis and S. aureus, as opposed to other articles who describe mostly enterobacteriaceae. 4. Outcome is favorable, mostly with medical treatment and percutaneous drainage.
J. Montagud
Objective; To determine the microbiological and clinical features, complications and prognosis of the infectious endocarditis (IE) in the old patient. Methods: We conducted a retrospective study of the cases of IE diagnosed in our hospital from January 1992 to March 2003 in patients older than 65. Diagnosis was based on modified criteria of Duke. Results: We found to have IE in 16 patients older than 6.5, with an equal distribution by sexes. Average age was 74 (rank 65-89). In 6 cases (375%) a previous well-known valvulopaty existed, with IE on the injured valve. The affected valve was mitral in 12 cases (75%) and aortic in 4 (25%). The most frequent symptom was fever (in 100%) which lasted between 1 day and 6 months. 5 cases (31.25%) had symptoms that pointed to EI: 2 peripheral embolisms (at retinal artery and hand), 2 cerebrovascular ischemic attacks and 1 recent heart failure. Blood cultures were positive in 100% of the cases, with: 3 Staphylococcus aureus, 2 Gemella morbillorum, 2 Streptococcus constellatus, 2 Enterococcus faecalis, 1 Salmonella enteritidis, 1 Streptococcus viridans, 1 Streptococcus epidermidis, 1 Escherichia coli, 1 Streptococcus pneumoniae, 1 Staphylococcus lugdunensis and 1 gram-negative bacillus not identified. The initial empirical antibiotic coverage was modified according to microbiological results. 4 cases (25%) required heart surgery with replacement of the affected valve due to residual heart failure. Global mortality was of 2 cases (12.5%) due to heart failure. The Average length of hospitalization was 35.44 days.
P313 Resistence and epidemiological study of tuberculosis hospital J. Gonzalez-Castillo, M.A. Lozano, S. Muiioz, P. Cubo, Merino (Madrid, E)
in a Spanish R. Caminero,
P.
Background: Tuberculosis is still an important disease with elevate prevalence in our country, due to Human Immunodeficiency Virus (HIV) infection and immigration. In this study we analyse if there is a new clinic presentation and an increase of primary resistance in the last years. Methods: Retrospective study of clinical charts from all patients income in our Hospital between 2000-2002 with diagnosis of tuberculosis. Epidemiological variables, risk factors, symptoms, treatment and resistance test were assessed. Results: 108 patients with tuberculosis diagnosis were recorded (55% male). Mean age was 37 years. 53% of patients were born in Spain while 43% were inmigrants from South America (70% of foreign people). 68% of subjects had a predisponent cause to suffer tuberculosis HIV infection diagnosis were present in 43% of patients. The more frequent localitation was pulmonary and most common sympton was respiratory. Widespread treatment stablish was Isoniazid, Rifampin and Pirazinamida (89%). A regimen with 3 drugs was prescrib in 61% of subjects and 4 drugs in 36% of them. Primary resistence was observed to Isoniazid, Rifampin, Pyrazinamide and Ethambutol in 6.4%, 2%, 0.9% and 6% of cases respectively.