Prognostic factors and mortality in immunocompetent adult patients hospitalized with community-acquired pneumococcal pneumonia Background: Streptococcus pneumoniae is the main cause of community-acquired pneumonia in adults. Aim: To describe baseline characteristics, risk factors and clinical outcomes of adult patients hospitalized with pneumococcal pneumonia. Material and methods: Prospective study of adult patients admitted for a community acquired pneumonia in a clinical hospital. Immune deficient patients and those with a history of a recent hospitalization, were excluded. Results: One hundred fifty one immunocompetent patients, aged 16 to 92 years, 58% males, were studied. Seventy five percent had other diseases, 26% were admitted to the intensive care unit and 9% needed mechanical ventilation. There were no differences in clinical features, ICU admission or hospital length of stay among bacteremic and nonbacteremic patients. Thirty days lethality for bacteremic and nonbacteremic patients, was 10.9% and 11.5%, respectively. The predictive values for lethality of Fine pneumonia severity index and CURB-65 (Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older) had an area under the ROC curve of 0.8 and 0.69, respectively. Multivariate analysis disclosed blood urea nitrogen over 30 mg/ dL (odds ratio (OR), 6.8), need for mechanical ventilation (OR, 7.4) and diastolic blood pressure below 50 mmHg (OR, 3.9), as significant independent predictors of death. Conclusions: Pneumococcal pneumonia was associated with a substancial rate of complications and mortality. Clinical presentation and outcome did not differ significantly among patients with and without bacteremia (

Caso Clínicowww.sochinf.cl 363Tumor cervical por Salmonella Typhimurium como forma de presentación clínica de SIDA en un paciente con infección por VIHSebastián Paredes E., Constanza Norambuena N., Sylvia Echavarri V. y Martín Lasso B.Cervical mass caused by Salmonella Typhimurium as a clinical presentation of AIDS in a HIV-positive patientInfections due to non-typhi salmonellae (NTS) generally cause a mild and self-limited gastrointestinal disease. However, there have been reports of atypical and severe presentations in immunocompromised patients. We report the case of a male patient who consulted with a cervical mass. He was found to be HIV-positive and Salmonella Typhimurium was isolated in one blood culture and cervical mass tissue culture. We discuss the relevance of infections by NTS in immunodefi cient patients because they present with more severe illness than normal population. We emphasize the importance of NTS bacteremia as a marker of underlying immunodefi ciency. We present some localized infection sites reported in the literature and their relation with particular diseases. We discuss the future relevance that an early start of antiretroviral therapy (ART) may have in HIV patients with NTS acute bacteremia or focal infections. Because infections by NTS can be severe and highly lethal they must be considered in the differential diagnosis of causative organisms of localized infections and bacteremia in HIV patients.