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Spondylodiscitis is rarely observed in association with infective endocarditis (IE). In the study presented here, 92 cases of definite IE were examined. Spondylodiscitis was present in 14 (15%) cases. The mean age of patients with spondylodiscitis was 69.1+/-13.6 years (range, 33-87 years). The male-to-female ratio was 8:6. Predisposing heart disease was found in nine (64.3%) cases. Back pain was reported in all cases. Spondylodiscitis was diagnosed before endocarditis in all cases. The infection affected the lumbar spine in 10 (71%) cases. A bacterium was isolated in all cases: group D Streptococcus ( n=5; 35.7%), coagulase-negative Staphylococcus ( n=4; 28.6%), and others ( n=5). Endocarditis affected predominantly the aortic valve (43%). The outcome was favourable in 12 cases. No differences in clinical features, evolution of disease, or laboratory values were found between IE patients with and IE patients without spondylodiscitis. Spondylodiscitis does not appear to worsen prognosis of IE, although the need for cardiac valve replacement seems to be more frequent in IE patients with spondylodiscitis. IE should be included in the differential diagnosis in patients with infectious spondylodiscitis and risk factors for endocarditis. In such patients, echocardiography should be performed routinely.

In view of its localization, brain abscess (BA) usually requires medical and surgical care. A broad spectrum of bacteria is involved. Recent reports stress the increasing frequency of anaerobes, but their impact has not been well evaluated. A retrospective review was conducted of all episodes of documented BA admitted in a tertiary-care hospital over a 10 y period. BA due to anaerobic bacteria (group A) were compared with other cases (group B) to determine the frequency and eventual characteristics of BA with isolated anaerobic bacteria. Between 1991 and 2000, BA were diagnosed in 42 patients (28M, 14F, mean age 54.6 y). No differences in clinical features and laboratory findings were found between patients with BA caused by anaerobic (n = 22) and only aerobic (n = 20) bacteria. Using appropriate microbiological techniques, 41 anaerobic bacteria strains were isolated in 22 of 42 patients (52.4%) with BA. Anaerobic bacteria were associated with aerobic strains in 5 patients (12%), whereas in 17 patients (40.5%) only anaerobic strains were isolated in cerebral puncture cultures. The most frequently isolated species were Fusobacterium nucleatum (n = 14), Prevotella sp. (n = 8), Actinomyces sp. (n = 6) and Bacteroides sp. (n = 4). Compared with group B, group A had more cases of a single abscess (p = 0.03) and ear, nose and throat (ENT) as a source of infection (p = 0.04), and seemed to have a better outcome (p = 0.07). These results emphasize the important role that anaerobic bacteria play in BA. The presence of such pathogens must be evoked when faced with a single abscess, an ENT infection, or both. Therapy should take into account this high frequency.

The aim of this retrospective study was to determine the underlying diseases associated with Pneumocystis carinii pneumonia (PCP) in immunocompromised HIV-negative patients and to identify prognosis factors in this population. One hundred three cases of PCP were diagnosed over a 5-year period. Diagnosis was established on the basis of clinical features and by detection of Pneumocystis carinii cysts in bronchoalveolar lavage fluid. Underlying diseases comprised hematologic malignancies (n=60; 58%), inflammatory diseases (n=27; 26%), and solid tumors (n=18; 17.5%); 9 (8%) patients were solid organ transplant recipients. Seventy-one (69%) patients received cytotoxic drugs, 57 (55%) were treated with long-term corticotherapy, and 15 (14.7%) underwent bone marrow transplantation. Fifty-eight (56%) patients were admitted to the intensive care unit, and 52 (41%) required mechanical ventilation. Thirty-nine (38%) patients died of PCP; data from these patients were compared with those from surviving patients. The following factors were associated with a poor prognosis: high respiratory rate (P=0.005), high pulse rate (P=0.0003), elevated C-reactive protein (P=0.01), elevated serum lactate dehydrogenase level (P=0.02), and mechanical ventilation (OR, 14.4; 95%CI, 5-50). The results suggest that PCP can occur during the course of many immunosuppressive diseases, particularly various hematologic malignancies. The diagnosis of PCP should be considered more frequently and advocated earlier in immunocompromised HIV-negative patients, since prompt diagnosis may improve the prognosis of these patients.