[Vibrio alginolyticus and swimmer's otitis externa. 2 cases and review of the literature]

We describe two patients with acute diffuse external otitis (swimmer's otitis) acquired in the Mediterranean shore, with Vibrio alginolyticus recovered from ear fluid. We describe the biochemical profile and sensitivity pattern (MIC) of both strains, comparing it to previously published data. A literature review was also performed, in which we found evidence for increasing concern of V. alginolyticus as an human pathogen. Also there is a need for considering halophilic vibrio as potential pathogens, specially if there is also epidemiologic support.

Capnophilic and anaerobic bacteremia in neutropenic patients: an oral source

The currently accepted empiric antibiotic therapy for bacterial infections in neutropenic patients may not cover the possibility of capnophilic and anaerobic bacteremia. Many of these infections develop in patients with severe mucositis or periodontitis, and the type of organisms recovered also suggests an oral source of infection. We present two cases of bacteremia in neutropenic patients who had been empirically treated with ceftazidime and piperacillin plus amikacin. In the first case a beta-lactamase-producing strain of Capnocytophaga ochracea was isolated; in the second case bacteremia was due to a mixture of Leptotrichia buccalis and Fusobacterium nucleatum. These observations emphasize the necessity for a reevaluation of the possible use of antimicrobial agents active against beta-lactamase-producing capnophilic organisms and anaerobic bacteria during empiric therapy in neutropenic patients with an oral source of infection.

Visceral leishmaniasis (kala-azar) as an opportunistic infection in patients infected with the human immunodeficiency virus in Spain

In an area endemic for visceral leishmaniasis, 16 patients with human immunodeficiency virus (HIV) infection developed the disease. All belonged to populations at risk for AIDS (15 were intravenous drug abusers). Five patients fulfilled the criteria for full-blown AIDS, and two more fulfilled them after diagnosis of leishmaniasis. All presented with the classic manifestations of visceral leishmaniasis, but leishmania serology was negative in 15 patients (93%). Leishmania donovani amastigotes were identified in the bone marrow in all cases. Most patients responded initially to treatment with pentavalent antimonial drugs, but seven (43%) followed a chronic course, with multiple relapses in five, despite alternative treatments. Visceral leishmaniasis occurred in patients with different levels of depression of the CD4 to CD8 lymphocyte ratio. Mortality was 37% (six patients) and was independent of the chronic-relapsing course of the disease. In no case was leishmaniasis the primary cause of death. Our data establish that visceral leishmaniasis is an opportunistic infection in HIV-infected patients, and we suggest that in endemic areas it should be considered an indicator disease for the diagnosis of AIDS.

[Pneumonia caused by Mycoplasma pneumoniae]

Mycoplasma pneumoniae is a common causative agent of community acquired pneumonia. To assess its epidemiological, clinical and evolutive features in our area, we retrospectively analyzed 88 instances which occurred during 10 years. Both sexes were similarly involved, with a higher incidence in younger patients (mean age: 22 years). A clear seasonal predominance was not detected during the study period. In nearly one half of instance there were similar respiratory episodes in the same household. Cough was a constant symptom, followed by fever and headache. The absence of leukocytosis and the presence of cryoagglutinins were suggestive data. Pulmonary infiltration in the chest radiogram was unilateral in most cases, with a segmental distribution and predominating in the lower lobes. Hilar lymph nodes, pleural effusion and cavitation were present in a limited number of instances. All patients were cured without sequelae. The occurrence of particular epidemiological, clinical and laboratory data may be very helpful in suggesting the diagnosis of pneumonia due to Mycoplasma pneumoniae.

[Pneumococcal endocarditis: apropos of 3 cases]

Streptococcus pneumoniae is a common pathogen in man. The incidence of endocarditis caused by this organism has diminished in the last decades, and now it is an exceptional condition. Three patients with pneumococcal endocarditis are reported. Their clinical and epidemiological features are reviewed and compared with previous literature. One of the instances was due to a strain with high resistance to penicillin; vancomycin was a valid alternative therapy.

Shigella sonnei bacteremia in an elderly diabetic patient

A case of Shigella sonnei bacteremia in a 65-year-old patient suffering from diabetes mellitus is discussed. The isolated strain had plasmid-mediated serum resistance and excreted aerobactin. The presence of diabetes mellitus as an underlying disease and the production by the Shigella sonnei isolate of factors related to bacterial invasion may have contributed to the bacteremic episode.