Current understanding and management of chronic hepatosplenic suppurative brucellosis

To outline the characteristics and define appropriate management of chronic hepatosplenic suppurative brucellosis (CHSB), 905 patients with brucellosis were analyzed. Sixteen episodes of CHSB (14 in the liver and 2 in the spleen) were found in 15 patients. Six patients had had previous remote brucellosis. Twelve patients presented with systemic symptoms, and 12 with local symptoms. Cultures of blood samples yielded negative results in all cases except 1, and the results of cultures of pus specimens were positive for Brucella melitensis in only 2 cases. All patients showed calcium deposits surrounded by a hypodense area on computed tomography. Patients often had low titers of agglutinating antibody. In patients who were receiving conservative management, early response was successful in 50% and late response was successful in 33.3%. In the patients who underwent surgery and concomitant antibiotic therapy, early and late response was successful in 100%. Thus, CHSB mainly represents a local reactivation of previous brucellosis. Its diagnosis may be difficult to establish and surgery may be required to cure many patients.

[Respiratory syncytial virus infection in adult patients hospitalized with community-acquired pneumonia]

OBJECTIVE

To determine the incidence and distribution of infection caused by respiratory syncytial virus (RSV) in hospitalized adults with community-acquired pneumonia.

PATIENTS AND METHODS

Patients were immunocompetent adults hospitalized with community-acquired pneumonia, who were prospectively studied in our hospital. As a part of the diagnostic protocol, we performed RSV serology with paired acute and convalescent phase sera of patients admitted between February 1995 and May 1997. Clinical and epidemiological characteristics of patients with and without acute infection were compared.

RESULTS

Paired RSV serology was performed in 250 patients hospitalized with community-acquired pneumonia. 97% of them had presence of IgG antibodies but only 17 patients (6.8%) had serologic evidence of acute infection; of these, seroconversion was observed in eight and positive IgM in nine. Fourteen cases with acute infection (82%) occurred between November and May. Three patients had pneumococcal pneumonia, 2 Legionella pneumophila and 12 pneumonia of unknown etiology. There were no clinical differences between patients with and without RSV acute infection but those with acute infection had more frequently bilateral involvement in chest radiography and a greater proportion of pneumonias of unknown etiology.

CONCLUSIONS

RSV is a cause of acute infection among adults hospitalized with community-acquired pneumonia, mainly between November and May. Further studies to assess the role of RSV as a causative agent of pneumonia in this population are needed.

[Osteonecrosis in systemic lupus erythematosus. Report of 3 cases]

We present three cases of patients with systemic lupus erythematosus (SLE) and osteonecrosis or avascular necrosis (AV). Although, the pathogenesis of osteonecrosis is controversial and multifactorial, the glucocorticoids therapy is the most important factor contributing to the lesion. We report the clinical presentation of the three patients. We comment the characteristics of AV, the diagnosis and the treatment of this uncommon complication in SLE patients.