P314 Outcome and clinical differences between pneumococcal pneumonia with and without bacteremia

Abstracts

I European

Journal

of Internal

Conclusions: Tuberculosis is still an important disease in Spain due to immigration, from South America mostly, and HIV infection. There is a high number of primary resistences to Isoniazid, so a 4 regimen drugs treatment must be prescribed initially while resistance test is done.

P314 Outcome and clinical differences between pneumococcal pneumonia with and without hacteremia F. Jover, J.M. Cuadrado, L. Andreu, R. Caiiizares, S. Martinez, M. Rodriguez, V. Ortiz, P. Roig (Alicante, E) Background: Few attempts have been made to compared bacteremic and nonbacteremic pneumococcal pneumonia, mainly because the difficulties to gain agreement on which cases represent nonbacteremic pneumococcal pneumonia. Recently, immunochromatographic assay for detection of S. pneumoniae urinary antigen has been successfully evaluated for the diagnosis of pneumococcal pneumonia. Objectives: 1) To examine and compare clinical and radiological features, risk factors and outcome associated with bacteremic and nonbacteremic groups. 2) To study vaccine indications in patients with pneumoccocal pneumonia according the 1997 ACIP recommendations. Methods: A retrospective study (1995-2003) analysing the clinical records of patients diagnosed of pneumococcal pneumonia in our institution was performed. S. pneumoniae were identified by blood cultures (bacteremic group) and detection of urinary antigen (nonbacteremic group). Results: There were 95 patients (70 bacteremic and 25 nonbacteremic). In 7 nonbacteremic cases another aetiology was detected (Legionella, 1 case and C. pneumoniae. 6 cases). Table 1 shows the main differences between the two groups. Overall mortality was 9.5% (without group differences). 8 1% cases fulfilled the ACIP vaccine recommendations, although different strengths of evidence were observed (grade A, 57%). Conclusion: 1. In our study, smoking is the leading risk factor for pneumococcal pneumonia. However, current smokers have an increased risk of bacteremic forms and former smokers and COPD developed nonbacteremic forms more frequently. 2. Bacteremic patients need a more prolonged intravenous antibiotic treatment than nonbacteremic patients. 3. In accordance with previous studies, the majority of our patients fulfilled the ACIP recommendations. Then, pneumococcal vaccination should be emphasized in persons at highest risk.

P315 Ten years review of Leptospirosis in an Internal Medicine ment F. Rolim, F. Barros, M.R. Pelejao, M.M. Noronha, C. Concalves, Costa, M. Chumbo, M. Costa Matos (Cascais, P)

Table

DepartF. Dias

1 Bacteremic

Nonbacteremlc

P

Mean age i year\)

39.8

70 8


COPD

18%

40%

0.033

Liver di\ea\e

16% 10% 178

0% 16% 4m

0.018 0 024 0 004 0.02 I

Current \mokrr Former *maker Alcohol abwe

304

8%

HIV mtection

23%

ox


Da)\ of ~nt~+venousantibiotic treatment

6

4.5

0.006

Length of hoapitahsation

7.9

6.X

0.07 I

COPD: deficiency

Chronic virus.

obstructive

pulmonary

disease.

HIV:

human

immuno-

Medicine

14 (2003)

Sl-S159

s119

Leptospirosis is an infectious disease caused by a spirochete belonging to the Leptospiraceae family. It is a zoonosis with worldwide distribution. Most frequently occurs in the tropics but is also frequent in temperate climates. The authors review the cases of leptospirosis admitted to the Internal Medicine Department of a Portuguese hospital for the past 10 years, The diagnosis is based on clinical suspicion and comproved by laboratory screening (urine isolation of leptospires, seroconversion and rise in the antibody titer in the microscopic agglutination test). Leptospirosis was diagnosed in 7 patients, 4 men and 3 women. The cases in witch it was possible to determine epidemiologic factors, three cases had contact with rodents, two cases water was the vehicle of transmission and in the other case contact with cattle was documented. Clinical manifestations were several: All patients had jaundice, 85% had hepatomegaly, 71% fever, 57% myalgias and abdominal pain. Nausea, vomiting, conjuntival suffusion, headache, hemorrhagic rash and dehidratation occurred in 43% of the patients, while arthralgias and diarrea occurred in 29%. Laboratory findings: All patients had thrombocytopenia, renal failure, elevation of aminotransferases, elevation of bilirubin and creatinine phosphokinase serum levels. The elevation of erythrocyte sedimentation rate occurred in 71% of the patients, as well as leucocytosis. Few patients had elevation of alkaline phosphatase and amylase serum levels. The seroconvertion and the antibody titer were positive in all patients, and leptospires were isolated in the urine in only one patient. The average time of hospitalization was 20.8 days. All patients did intravenous antibiotics. One patient died, all others had a favourable evolution, Leptospirosis must be of clinical suspicion in the presence of epidemiologic history and clinical manifestations. The urine isolation of leptospires, seroconversion and the antibody titer are sensible and specific. Precocity in diagnosis and treatment is fundamental as the illness can be fatal

P316 Neurocysticercosis in Spain: J. Lobo, J. Gonzalez-Castillo, (Madrid, E)

an emerging problem M. Abad, J.A. Nuevo,

P. Cubo,

S. Munoz

Background: Neurocysticercosis (NC) is produced by taenia solium. It is the most frequent parasitic disease of central nervous system in human, representing a common reason of epileptic crises in developing countries, Nowadays, an increase in diagnosis is taking place at developed countries due to immigration from areas where parasite is endemic. In our study we analysed our experience with this disease. Methods: Retrospective study of clinical charts from all income patients with NC diagnosis in our hospital. Epidemiological variables, clinical presentation, information gathered in the physical exploration, find in the magnetic resonance or computed tomography and the established treatment were assessed. Results: From 1998 to 2002, 16 cases of NC were diagnosed in our hospital. Mean age was 30 years (6 males). 15 patients were from South America, mostly from Ecuador (9). Symptom most frequent at diagnosis was epileptic crises (11 subjects) and migraine (3). Neurological exploration was normal in 14 subjects, Multiple locations of injuries were observed in 7 patients. Most frequent site of injuries was parietal lobe (lo), frontal and occipital lobe (7). There was ventricular affectation in 5 patients. Stage more frequently was colloidal (8), calcification (7) and vesicular (5). Specific treatment with antiparasitic was restored in 15 subjects. Albendazol was used in 14 patients and praziquantel in one. 12 of patients received epileptic treatment and 3 corticosteroids. Conclusions: Neurocysticercosis is a potentially fatal condition with high morbidity. Intraventricular cysts obstruct is the more dangerous condition leading to hydrocephalus. Neuroimaging remains as the most important diagnosis study. The treatment of neurocysticercosis is symptomatic, based on dexamethasone, to alleviate cerebral edema and inflammation, and epilepsy treatment. Anthelmintic medications hasten the natural evolution to death of parasite, so is not clear the real benefit of