RESUMEN
Isolated infective endocarditis in the native pulmonary valve is an unusual clinical entity in patients without predisposing factors and in non-intravenous drugs users. We present the case of a 75-year-old patient, with a subacute clinical picture of fever and pulmonary cavity nodules, admitted to our hospital with an initial suspected diagnosis of pulmonary tuberculosis. The presence of Enterococcal bacteremia in hemocultive and the documentation of a large vegetation in pulmonary valve by transtoracic and transesophageal echocardiography were key factors for final diagnosis.
Asunto(s)
Endocarditis Bacteriana/diagnóstico , Enterococcus faecalis , Infecciones por Bacterias Grampositivas/diagnóstico , Válvula Pulmonar , Anciano , Humanos , MasculinoRESUMEN
Severe infections caused by Pseudomonas aeruginosa are uncommon in patients infected with HIV. These infections are usually recurrent, bear a poor prognosis and their potential for nosocomial transmission is questioned. From May 1991 to December 1994, a total of 2,739 admissions were recorded at the VIH Unit in our hospital. Seven of those patients suffered 9 episodes of P. aeruginosa bacteremia (3.28 episodes/1,000 admissions). All cases were acquired nosocomially. The mean CD4 count was 30.7 cells/ml. Mortality associated with Pseudomonas aeruginosa bacteremia was 43%. With molecular typing techniques homologies over 98% were demonstrated for the two episodes in patient 4 and the episode in patient 3 (very close in time, 1993) and almost 99% between the isolate from patient 7 and the two isolates (identical) from patient 6. The other three isolates had relationship (to themselves and to the other isolates) lower than 97%. Our findings suggest that patient-to-patient transmission of severe infections caused by P. aeruginosa in patients with AIDS.