Infections of the lower urinary tract are characterised by localised pain, which increases when urinating, and sometimes by cloudy or dark urine, usually without high temperatures.

Kidney infections (pyelonephritis) are characterised by high temperatures, acute local pain in the lower back, and pain or irritation when urinating.

Symptoms

Urinary tract infection is characterised by the presence of local pain (lower abdomen or lumbar region), which increases when urinating. The urine is often cloudy, or dark if it contains blood. There may be high fever, especially in the case of pyelonephritis (an infection of the upper urinary tract).

Who is affected by the condition?

It can affect people at any age, from early childhood to old age. It is more frequent among women and there are factors that make people vulnerable to it (pregnancy for women and enlarged prostate for men) as well as urological anomalies (pre-existing malformation or presence of kidney stones).

Diagnosis

Urinary infections are diagnosed by examining urine under the microscope (sediment) to see whether it contains white blood cells and/or bacteria, and by cultivating the bacteria in a microbiological culture to identify the strain and determine the most appropriate antibiotic for treatment (antibiotic susceptibility testing).

Standard treatment

Urinary tract infections are usually treated with antibiotics. Treatment is oral in the case of lower-tract infection.

For upper-tract infections (pyelonephritis) it is usually intravenous, although in some cases outpatient oral treatment may be administered.

Standard tests

The standard tests are urine sediment and culture (urine culture with antibiotic susceptibility testing). An ultrasound scan may be indicated for examining the kidney and urinary tract and identifying obstructions or kidney stones that may have brought about the infection.

Ultrasounds are also used to assess the state of the kidneys. A general analysis may also be indicated to see how the urinary tract infection is affecting the rest of the body, and specifically the renal function.

Prevention 

Urinary tract infection can be prevented by frequent urination (every 2 to 3 hours) and, above all, by avoiding the habit of holding in urine, and by going to the toilet whenever the bladder feels full, without waiting too long.

Symptoms

Legionellosis produces the typical symptoms of pneumonia—fever, chest pain, and difficulty breathing—along with severe muscle pain and a significant overall decline in health, with pronounced malaise.

Who is affected?

Legionellosis can affect anyone who comes into contact with the causative bacterium, but it is more common in elderly or immunocompromised individuals who have been exposed to contaminated water or inhaled vapor from such water.

Diagnosis

Diagnosis is made by detecting the bacterium or antibodies against it in the blood, once suspected based on clinical characteristics (age of onset, fever, severe general malaise, muscle pain) or radiographic findings (pneumonia affecting large areas of the lungs). Isolation of the bacterium is relatively recent, as it requires special culture media.

In fact, Legionella was not identified as a cause of pulmonary disease until 1976, during a pneumonia outbreak at an American Legion convention in Philadelphia, from which it gets its name.

Usual treatment

Legionellosis responds well to specific antibiotic treatment. Early initiation of treatment is very important.

Common tests

Chest X-ray, blood tests for antibodies against Legionella, and specific cultures to identify the bacterium.

Prevention

Epidemiological surveillance of detected cases (water pipes, air-conditioning towers, pools, or hot tubs involved) is crucial to disinfect them.

When a case of legionellosis is detected, public health authorities conduct an investigation to locate and eliminate the source.

Legionella does not tolerate high temperatures well and is usually eliminated by temporarily raising the temperature of the water systems. To ensure the bacterium is fully eradicated, these measures should be carried out by specialized professionals.

Infective endocarditis primarily affects the heart valves, whether natural or artificial, although it can sometimes involve other structures of the heart. It is classified according to the duration of the infection (days, weeks, or months) and the type of causative microorganism (bacteria, yeast, or fungi).

The characteristic lesion of infective endocarditis is the endocardial vegetation. This consists of an abnormal aggregate of platelets, fibrin, bacteria, and inflammatory cells that adheres to the inner surface of the heart—typically a heart valve—and can detach, causing infectious emboli in distant organs such as the skin, nervous system, or extremities.

It is considered a serious disease. Although most cases are curable, it carries significant complications and mortality even with treatment. In many cases, achieving a definitive cure requires surgical intervention to remove affected tissue and replace the valve with an artificial one.

Symptoms

In the acute form, infective endocarditis may cause high fever, chills, prostration, and rapid deterioration of general condition over hours or days.

In subacute forms, with progression over weeks or months, the main symptoms are fatigue, loss of appetite, and mild fever. In these cases, characteristic skin lesions, such as nodules or spots, may also occur, although not always.

In patients with severe valve involvement, valvular dysfunction may develop, resulting in heart failure symptoms, such as significant shortness of breath and edema in the lower limbs.

Who is affected

Infective endocarditis has a global incidence of 2–3 cases per 100,000 people per year. In Catalonia, around 200 new cases are diagnosed annually. Its incidence increases significantly with age, reaching 15–30 cases per 100,000 people per year in individuals over 65—about 10 times higher than in younger populations.

The causative agents have changed over recent decades. Previously, streptococci, particularly viridans streptococci, were the most common. Currently, the most frequent pathogens are staphylococci, followed by streptococci and enterococci. However, any microorganism present in the blood can adhere to a heart valve, especially if it is previously damaged or artificial.

Diagnosis

Diagnosis is primarily based on:

-blood cultures: to identify the causative microorganism and guide selection of the appropriate antibiotic therapy.

-echocardiography: to locate endocardial vegetations, assess valve function, and determine the need for surgery in certain patients.

In some cases, additional imaging (CT scans, nuclear medicine scans) is necessary to detect peripheral emboli, which are common at diagnosis or during treatment.

Usual treatment

Treatment of infective endocarditis is antibiotic therapy, specifically targeted at the causative microorganism. Doses are high and prolonged, because vegetations are poorly vascularized and the antibiotic must penetrate by diffusion from circulating blood.

Patients who do not respond adequately to antibiotic therapy, or who develop significant valvular damage, may require valve replacement surgery.

Common tests

Blood cultures and echocardiography, both at diagnosis and during follow-up, to monitor disease progression.

Prevention

In individuals with known valvular abnormalities, antibiotic prophylaxis is recommended before dental procedures or gum surgery, following specialist guidance.

Preventive measures should also be taken during endoscopic procedures, especially upper gastrointestinal endoscopy (gastroscopy), according to the prescribed antibiotic regimen.

This prevention is crucial because the presence of bacteria in the bloodstream during such procedures significantly increases the risk of infective endocarditis.

Patients with Sjögren's Syndrome often have other conditions related to anomalous functioning of the immune system, such as systemic lupus erythematosus, scleroderma and rheumatoid arthritis.

Symptoms

Patients with Sjögren's Syndrome mainly have symptoms related to a lack of tear and saliva production, which causes dryness in the mouth and eyes. The main symptoms suffered by patients are a burning, gritty sensation in the eyes, red eyes, blurred vision, the need to drink water frequently, difficulty swallowing dry food and a higher propensity for tooth decay and mouth infections. This dryness may also affect the skin and vaginal area, which causes painful sexual relationships. Other symptoms that Sjögren's Syndrome patients may show are joint or muscle pain and fatigue. Less frequently, other organs, such as the lungs, kidney and nerve endings, may be affected.

Who is affected by the condition?

Above all, the disease affects women aged between 40 and 60. It is calculated that the incidence is between 0.5% and 3% of the population.

How is it diagnosed?

There is no single test enabling diagnosis of Sjögren's Syndrome.  Diagnosing Sjögren's Syndrome in a patient referred with dry eyes and mouth is based on tests that confirm the existence of a deficit in tear and saliva production and that prove that the dryness is associated with an imbalance in the immune system.

Standard treatment

Treatment of Sjögren's Syndrome is essentially based on measures that alleviate the feeling of dryness shown by the patient. The treatment includes the use of artificial tears, eye gels, eye drops, nebulisers and tablets to stimulate saliva production. Particular patients may be given treatment to stimulate glandular secretion. In serious cases, where there are symptoms in organs other than the glands (lungs and peripheral nerves, etc) it may be necessary to administer medication that acts to decrease immune system activity (immunosuppressant drugs).

Standard tests

Patients with Sjögren's Syndrome must undergo a series of eye tests, blood and urine tests and, on certain occasions, it is necessary to do a small biopsy of lip mucous to confirm the existence of inflammation in the glands producing saliva.

The femur is the longest bone in the human body. It should be stated that a femoral fracture in elderly people basically affects the end nearest the hip joint. For this reason, the best-known name for this type of fracture is hip fracture. We should not understand this health problem as a fracture of a long bone that affects an elderly person, but rather as a gateway leading to their physiological and functional situation, and their underlying conditions, becoming decompensated.

The symptoms

The classic symptoms are pain in the hip area, reported by the patient themselves, when they can, along with the associated functional impotence. Furthermore, the affected limb tends to be shorter and presents external rotation (with the lateral side of the foot touching the bed). In patients with cognitive deterioration, who cannot communicate the level of pain they are suffering, a decrease in their functional situation can be a symptom that should make us suspect a “hidden” fracture.

Who is affected by the condition?

The population incidence of hip fractures in Catalonia for patients aged > 65 is around 600 cases / 100,000 inhabitants per year. The perspective is that this figure will increase in coming years, due to the increase in life expectancy and an increasing population.

At Hospital Vall d'Hebron in 2020, the year of the Covid-19 pandemic, we operated on a total of 693 hip fractures. In 2019, surgery was performed on 720 fractures. In other words, these are fractures that occur under normal circumstances of patients falling over.

The average age where this occurs is 85 years old, and it affects women in 75% of the cases. Some of the risk factors for women may be early menopause and hormonal treatment. A prior fracture (radius or spine are the most frequent), obesity, smoking and a sedentary lifestyle are risk factors in general.

Diagnosis

The suspected diagnosis can be made from typical clinical signs and symptoms, as stated above.

Usual treatment

In regard to treatment, it has been demonstrated that surgery on hip fractures in the elderly population increases survival, when compared to a non-surgical treatment, as it permits the patient's early movement without pain, thereby avoiding added complications. For this reason, at present, the treatment of choice is surgical treatment. However, there are some exceptions.

A multi-disciplinary approach is important, with the collaboration of specialists in geriatrics, internal medicine and anaesthesiology for the preoperative optimisation of the patient and early surgery, as a rule within the first 48 hours.

It is essential to classify the fractures according to their location, in order to decide on the type of surgical treatment. Intracapsular fractures seriously affect the vascularisation of the femoral head, and for this reason, the most popular option for treatment is to replace it with an artificial head, in the form of a hip prosthesis, especially in displaced fractures. Depending on the patient's age and functional situation, we may opt for a partial or total prosthesis, reserving the second option for younger patients with a better quality of life. Some non-displaced intracapsular fractures can be treated percutaneously, using screws. Extracapsular fractures, of which pertrochanteric fractures are the most common, do not compromise the vascularisation of the femoral head, and for this reason it is not necessary to replace it with a prosthesis. Percutaneous treatment with intramedullary nailing is usually the treatment of choice.

The postoperative period is also very important. Close collaboration with rehabilitation and physiotherapy services is established so that patients do not lose their prior functional capacity. Furthermore, social workers assess the social situation of each patient, in order to ensure an appropriate hospital discharge.

The most common tests

Diagnosis confirmation is usually carried out with a simple x-ray of the pelvis. In cases where the x-ray does not show a fracture, as may occur in the case of some non-displaced intracapsular fractures, tomography (CAT) is usually the technique of choice.

Prevention

Hip fracture prevention is based on the adoption of healthy habits, such as a balanced diet that is rich in calcium and vitamin D, doing physical activity every day, within the person's functional capacities, and avoiding tobacco and alcohol.

It is also important to prevent falls, by means of appropriate closed footwear with a non-slip sole, standing up slowly, without haste, programming visits to the toilet to avoid rushing, wearing glasses and hearing aids, not walking in the dark or on went floors, etc.

In recent years, improved knowledge of these diseases has made it possible to correctly diagnose autoimmune diseases at an early stage, allowing us to establish appropriate treatment regimens to reduce the damage that they cause.

The primary therapeutic strategy for tackling these diseases revolves around the modulation of the immune system. Various immunosuppressants and the use of molecules targeting key components of the immune system can restore, to some extent, or at least minimise the abnormal immune response associated with these disorders. The considered use of these treatments will make it possible to deliver personalised, precision therapy to patients suffering from these diseases in the near future.

Vasculitis in its different forms (depending on the calibre of the vessels), lupus, antiphospholipid syndrome, scleroderma and inflammatory myopathies are some of the classic systemic autoimmune diseases.