Síndrome de Reacción a drogas con Eosinofilia y Síntomas Sistémicos (DRESS) asociados a Nefritis Túbulo Intersticial Aguda en un adolescente / DRESS síndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) associated with Tubulo Interstitial Nephritis in a adolescent

Resumen El síndrome de DRESS (Reacción a drogas con eosinofilia y síntomas sistémicos) es una patología poco frecuente en Pediatría, descrita por primera vez en 1996, por Bocquet. Puede presentarse en un tiempo variable luego de exposición a algunos medicamentos, se caracteriza por fiebre, compromiso cutáneo y de órganos internos. En este caso, se presenta a un paciente de 13 años, con antecedente de uso de Trimetroprim sulfa desde hace 2 meses, con cuadro de 3 días consistente en fiebre y rash cutáneo, sin compromiso de mucosas, con respuesta no favorable al manejo con esteroide, requiriendo Inmunoglobulina IV. Semanas después del inicio de los síntomas y evolución estable presenta insuficiencia renal aguda que requirió terapia de reemplazo renal. Se descartaron otras patologías subyacentes de índole autoinmune. Hubo recuperación de azoados y normalización de los demás paraclínicos el día 40 de la enfermedad. El paciente continúa asintomático, 4 meses después, con tratamiento con esteroide oral, en descenso lento y gradual. Se debe considerar la evaluación permanente de las pruebas de función renal en los pacientes que presenten Síndrome de DRESS, por su asociación con Nefritis intersticial aguda y complicaciones relacionadas.

Abstract DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a rare pathology in Pediatrics, first described in 1996 by Bocquet. It can appear in a variable period of time after exposure to some medications, it is characterized by fever, skin involvement and internal organs. A 13-year-old patient is presented, with a history of use of Trimethoprim sulfa for two months, with a disease of three days of evolution, consisting of fever and skin rash, without mucosal involvement, with an unfavorable response to steroid management, requiring Intravenous inmunoglobulin. Weeks after the onset of symptoms and stable evolution, he presented acute renal failure that required renal replacement therapy. Other underlying autoimmune pathologies were ruled out. There was recovery of renal function test and normalization of the other paraclinical on day 40 of the disease. Patient remains asymptomatic four months later, with oral steroid treatment, in slow and gradual decline. Permanent evaluation of renal function tests should be considered in patients with DRESS syndrome, due to its association with acute tubulointerstitial nephritis and related complications.

YOKENELLA REGENSBURGEI osteoarticular infection: a case report

okenella regensburgei belongs to the family Enterobacteriaceae and is an opportunistic agent rarely associated with infections in humans. We report a case of osteoarticular knee infection caused by Y. regensburgei in a patient under treatment for rheumatoid arthritis, using corticosteroids, with complication in primary total arthroplasty of the knee. Y. regensburgei was identified using the VITEK2 system. Antimicrobial susceptibility testing was performed using the disk-diffusion method, according to the guidelines from the Clinical and Laboratory Standards Institute. The patient presented favorable clinical evolution after the second debridement, with complete removal of the prosthesis and antibiotic therapy with sulfamethoxazole/trimethoprim. This is the first case of Y. regensburgei infection described d in Brazil.

Loss of tolerance 5 days after discontinuing sulphonamide introduced via desensitization in delayed reaction / Perda da tolerância 5 dias após suspensão de sulfonamida introduzida através de dessensibilização por reação tardia

ABSTRACT The fixed drug eruption is a non-immediate hypersensitivity reaction to drug, characterized by recurrent erythematous or violaceous, rounded, well-defined border plaques, which always appear in the same location every time the culprit drug is administered. The usual practice is to avoid the drug involved and to use a structurally different drug. However, there are situations in which there is no safe and effective therapy. In such situations, desensitization is the only option. We describe the case of a patient who presented fixed eruption due to sulfamethoxazole-trimethoprim, who underwent successful desensitization, but required a repeat procedure twice due to relapse after inadvertent full-dose reintroduction. In non-immediate hypersensitivity reaction to drug, the indication is controversial and there is no technical standardization. Furthermore, the time at which such tolerance is lost after discontinuing the drug involved is unknown. In severe non-immediate reactions of types II and III, desensitization is contraindicated. The patient underwent desensitisation to sulfamethoxazole-trimethoprim three times − the first with recurrence of lesions and the second and third without manifestations, all concluded successfully and with no premedication.

RESUMO A erupção fixa por drogas é uma reação de hipersensibilidade a medicamento não imediata, caracterizada por placas eritematosas ou violáceas, arredondadas, recorrentes, de bordas bem definidas e que aparecem sempre na mesma localização cada vez que o medicamento culpado é administrado. A prática habitual é evitar a droga envolvida e utilizar um medicamento estruturalmente diferente. Contudo, há situações em que não há terapêutica segura e eficaz. Em tais situações, a dessensibilização é a única opção. Descrevemos o caso de um paciente que apresentou erupção fixa por drogas por sulfametoxazol-trimetoprim, tendo sido submetido à dessensibilização com sucesso, mas necessitou repetição do procedimento duas vezes, por recidiva da reação após reintrodução inadvertida em dose plena. Em reação de hipersensibilidade a medicamento não imediata, a indicação é controversa e não há padronização técnica. Além disso, não se conhece o tempo durante o qual essa tolerância é perdida após a suspensão da droga envolvida. Nas reações não imediatas graves e dos tipos II e III, a dessensibilização está contraindicada. O paciente foi submetido a dessensibilização ao sulfametoxazol-trimetoprim por três vezes − a primeira com recorrência de lesões, e a segunda e terceira sem manifestações, sendo todas concluídas com sucesso e sem uso de pré-medicação.

Staphylococcus aureus procedentes de quesos costeños de Valledupar; susceptibilidad a antibióticos y perfil plasmídico / Staphylococcus aureus from Valledupar cheeses; susceptibility to antibiotics and plasmid profile

Resumen En este estudio se investigó la susceptibilidad a antibióticos y el perfil plasmídico de S aureus aislado de queso costeño, blando, semiduro y duro, expendidas en diferentes puntos de venta de la ciudad de Valledupar. Por el método de Difusión del disco en agar, se determinó la resistencia a antibióticos y con la técnica de lisis alcalina y electroforesis en gel de agarosa, el perfil plasmídico. Como resultado, se obtuvo una carga microbiana por encima de 103 UFC/g, que está sobre el valor promedio máximo permitido, según la norma covenin 1538-92, el cual indica que se puede desencadenar brotes por intoxicación con estafilocócos. Se demostró la presencia de S. aureus en los quesos costeños blandos (75%), seguidos por los quesos semiduros (25%) ambos de origen (artesanal), los cuales son de alto consumo en Valledupar. Se establecieron 4 patrones diferentes de resistencia en las cepas de S. aureus aisladas de los quesos, siendo el patrón TER común para dos cepas, el resto de los patrones fueron únicos (PR, CR y EI). Una cepa fue resistente a P, productora de β-lactamasas, su CMI más alta fue 32µg/ml; todas las cepas mostraron sensibilidad a oxacilina, gentamicina, ciprofloxacina, cefoxitin, clindamicina, trimetoprim sulfa, vancomicina, rifampin, e imipenen. Hubo bandas plasmídicas con tamaños de 23kb encontrándose cepas con 1 plásmidos.

Abstract In this study, the antibiotic susceptibility was investigated and the plasmid profile of S aureus isolated from coastal cheese, soft, semi-hard and hard, expended in different outlets of the city of Valledupar. For the method of diffusion of the agar disk, the antibiotic resistance was determined and with the technique of alkaline lysis and electrophoresis in the agarose gel, the plasmid profile. As a result, was obtained one microbial load, above of 103 UFC/g, which is on average the maximum allowed value, according to the standard covenin 1538-92, which indicates that it can trigger outbreaks by Staphylococcal poisoning. The presence of S.aureus in coastal soft cheese was shown (75%), followed by semi-hard cheeses (25%) both home (handmade), which are of high consume in Valledupar. four different resistance patterns were established in the strains of the S.aureus isolated from the cheeses, being TER the common pattern for five strains, the rest of the patterns were unique (PR, CR and EI). One strain was resistant to P, producer of the β-lactamases, the CMI more tall was 32µg/ml; All the strains show sensibility to oxacillin, gentamycin, ciprofloxacin, cephoxitin, clindamycin, trimetoprim sulfa, vancomycin, rifampin, and imipenem. There plasmid bands with sizes between 23kb, being 1 strains with plasmids.

Etiología y perfil de resistencia antimicrobiana en pacientes con infección urinaria / Etiology and antimicrobial resistance profile in patients with urinary infection

Introducción: La infección de vías urinarias (IVU) es una de las enfermedades más prevalentes en la práctica clínica Objetivo: Identificar los principales agentes etiológicos y la frecuencia de resistencia a antibióticos por parte de microorganismos aislados por urocultivos en pa cientes con IVU en un hospital de primer nivel de atención. Materiales y Métodos: Estudio descriptivo de corte transversal, a partir de una muestra aleatoria de pacientes con IVU en La Virginia, Risaralda, entre el 1 de abril de 2014 a 31 de marzo de 2015. Se evaluaron las bacterias aisladas en la totalidad de urocultivos procesados y los resultados de los antibiogramas. Se establecieron frecuencias y proporciones. Para el análisis de datos, se utilizó SPSS Statistics 22. Se hizo análisis multivariado. Resultados: Se realizaron 1563 urocultivos en el periodo de estudio, de los cuales 329 (21,0%) mostraron crecimiento mayor a 100.000 UFC. Las frecuencias más altas de resistencia para E. coli se observaron para cefalotina (75,8%), ampicilina (72,6%) y trimetoprim/sulfametoxazol (55,3%). De 296 pacientes seleccionados aleatoriamente se halló que la cistitis era la IVU más frecuente (70,3%) y al 50,7% no se les prescribió ningún antimicrobiano. El uso de antiulcerosos se asoció con mayor probabilidad de uso inadecuado del antibiótico (OR:4,28; IC95%:1,070-17,153; p=0,04). Conclusiones: Existe una elevada resistencia bacteriana a los antibióticos de primera línea para el tratamiento de las IVUs, lo que sugiere la importancia de identi ficar los microorganismos y sus perfiles de sensibilidad a antimicrobianos para seleccionar con mejor criterio cual emplear.

Introduction: Urinary tract infection (UTI) is one of the most prevalent diseases in clinical practice. Objective: To identify the main etiologic agents and the frequency of antibiotic resistance by microorganisms isolated from urine culture and sensitivity in patients with IVU in a hospital primary care. Materials and Methods. Descriptive cross-sectional study, from a random sample of patients with UTI in La Virginia, Risaralda, from April 1, 2014 to March 31, 2015. Bacteria isolated from all processed urine cultures and the results of susceptibility were evaluated. Frequencies and proportions were established. For data analysis was used SPSS Statistics 22. Results: A total of 1563 urine cultures were performed in the study period, of which 329 (21.0%) showed further growth to 100,000 UFC. Higher frequencies of resis tance were observed for E. coli to cephalothin (75.8%), ampicillin (72.6%) and trimethoprim/sulfamethoxazole (55.3%). In the 296 randomized patients it was found that the most common UTI was cystitis (70.3%) and 50.7% were not prescribed any antimicrobial. The use of anti-ulcer is associated with increased probability of inappropriate use of antibiotics (OR:4.28; 95% CI:1.070-17.153; p=0.04). Conclusions: There is a high bacterial resistance to first-line antibiotics for treatment of UTIs, suggesting the importance of identifying microorganisms and their antimicrobial susceptibility profiles to select which use better approach.

A case of atypical nocardia asteroides sclerouveitis resistant to fourth-generation fluoroquinolones / Um caso atípico de esclero-uveíte por Nocardia Asteroides resistente a fluorquinolona de quarta-geração

ABSTRACT We describe an unusual case of Nocardia spp scleritis in a health girl resistant to topical fourth-generation fluoroquinolones. Clinically, there was only partial response of the scleritis to initial therapy. Treatment was changed to meropenem intravenously and topical amikacin. Following several weeks of antibiotic treatment, the patient's infection resolved but her vision was reduced to no light perception. Nocardia asteroides must be considered as a possible agent in cases of necrotizing scleritis in patients without a clear source. Antibiotic sensitivity testing has a definitive role in view of the resistance to these new medications.

RESUMO Nós descrevemos um raro caso de esclerite por Nocardia spp em uma criança sadia resistente a utilização tópica de fluorquinolona de quarta-geração. Clinicamente, a paciente apresentou apenas uma resposta parcial do quadro de esclerite a terapêutica inicial. O tratamento foi então modificado para meropenem intravenoso e amicacina tópica. Após várias semanas de tratamento com antibiótico, o quadro infeccioso regrediu porém a visao da pacientes evoluiu para perda da percepção luminosa. Em casos de esclerite necrotizante em pacientes sem fatores de risco aparente é necessário considerer a Nocardia Asteroides como possível agente causador. Os testes de sensibilidade medicamentosa apresentam importância significativa em virtude do aparecimento de resistência aos novos medicamentos.

Plásmido conjugativo portador de integrón clase 1 responsable de la resistencia a los antibióticos en aislados de vibrio cholerae O1 en Venezuela / Conjugative plasmid and a class 1integron responsible for the resistance to antibiotics in vibrio cholerae O1 isolates in Venezuela

Se han descrito aislados de Vibrio cholerae resistentes a una amplia variedad de antibióticos. En Venezuela, durante el brote de cólera ocurrido entre noviembre de 1998 y enero 2000 fueron reportados por primera vez aislados de V. cholerae O1 resistentes a ampicilina, trimetoprim-sulfametoxazole. Usando experimentos de conjugación se determinó la capacidad de transferir los determinantes de resistencia a ampicilina y trimetoprim-sulfametoxazole en 11 aislados. La visualización de plásmidos se realizó utilizando la digestión con nucleasa S1 y electroforesis en campo pulsante. La presencia de integrones de clase 1 fue establecida por PCR y se obtuvo la secuencia de la región variable del integrón. Los determinantes de resistencia fueron transferidos en un plásmido conjugativo de aproximadamente 170 kbp, común a todos los aislados. La resistencia a trimetoprim esta codificada en el gen dfra15, el cual se encuentra en un integrón clase 1 presente en el plásmido. En este estudio, se caracterizó la localización genética de los determinantes que codifican la resistencia a los antibióticos, y al conocer el mecanismo probable de dispersión de los determinantes de resistencia se podrán implementar medidas de control más adecuadas.

Vibrio cholerae has been reported to be resistant to a wide range of antibiotics. V. Cholerae O1 strains resistant to ampicillin, trimethoprim-sulfamethoxazole were isolated for the first time in Venezuela during a cholera outbreak that occurred between November 1998 and January 2000. Using conjugation experiments, the capacity of transfer of the resistance determinants in 11 strains resistant to ampicillin and trimethoprim-sulfamethoxazole was investigated. Plasmid analysis was done by S1 nuclease digestion and pulsed field gel electrophoresis. The presence of class 1 integrons was determined by PCR and the sequence of the gene harbored in the variable region of the integron was obtained. The antibiotic resistance determinants were transferred by a conjugative plasmid of approximately 170 kbp, common to all the isolates. Resistance to trimethoprim is encoded by the dfra15 gene that is harbored by a class 1 integron present in the plasmid. In this study, the genetic location of the determinants that code for resistance to antibiotics was characterized, and knowing the probable mechanism of dispersion of the determinants of resistance, control measures can be implemented most appropriate

Bacteriemia asociada a catéter por Cupriavidus pauculus / Cupriavidus pauculus catheter related bacteremia

Cupriavidus pauculus es un bacilo Gram negativo con metabolismo oxidativo, que se ha aislado de muestras de agua y suelo, pero raramente de personas como entidad clínica. En la literatura científica existen menos de veinte artículos de reportes de caso de este microorganismo. La mayoría han sido pacientes con algún tipo de inmunosupresión, sometidos a procedimientos invasivos, especialmente de tipo vascular, y que han requerido múltiple manejo antibiótico. Cupriavidus pauculus ha mostrado baja virulencia y sensibilidad antibiótica, principalmente a trimetoprim-sulfametoxazol, betalactámicos de amplio espectro y quinolonas. Se presenta el caso de una paciente de 55 años con antecedentes de trasplante renal, que ingresó con infección de tejidos blandos y a quien se le diagnosticó bacteriemia asociada a catéter por C. pauculus durante la hospitalización.

Cupriavidus pauculus it’s a gram-negative bacillus with an oxidative metabolism that has been isolated in water and soil samples, but rarely in people clinical entities. There are less than 20 articles case-reported about this microorganism. Most of which have been patients with some type of immune impairment, mostly subjects with invasive vascular procedures, who had required multiples antibiotic management. Cupriavidus pauculus has mainly shown a low virulence and antibiotic sensibility to trimethoprim-sulfametoxazol, broad spectrum betalactamics and quinolones. As presented in the case of a 55 year old patient with renal transplantation history admitted with a soft tissue infection and diagnosed with a catheter associated bacteremia by C. pauculus, during hospitalization.

Prostatic paracoccidioidomycosis: differential diagnosis of prostate cancer

Symptomatic prostatic paracoccidioidomycosis (PCM) is a very rare condition; however, it may express as a typical benign prostatic hyperplasia or a simulating prostatic adenocarcinoma. This case report presents PCM mimicking prostatic adenocarcinoma. The purpose of this paper is to call the general physician's attention to this important differential diagnosis.

Acometimento intestinal da paracoccidioidomicose: relato de caso / Intestinal involvement of paracoccidioidomycosis: case report

A paracoccidioidomicose é uma moléstia gra»nulomatosa crônica, causada pelo fungo Paracoc»cidioides brasiliensis. Predomina no sexo masculi»no, adultos jovens oriundos, principalmente, da zona rural. Entre as formas clínicas, pode-se enc! contrar comprometimento digestivo, com incit dência variável, de acordo com o órgão conside»rado. O presente estudo relata um caso de para»coccidioidomicose com envolvimento do intestino delgado diagnosticado pela colonoscopia e his»topatológico, que evoluiu para um quadro de suboclusão intestinal pela fibrose do processo inflamatório decorrente da patologia. Através de revisão da literatura, são feitos comentários so»bre a doença de base, forma intestinal e suas complicaçoes clínico-cirúrgicas, enfatizando a raridade dessa apresentação clínica.

Farmacodermia associada a reações sistêmicas em um cão Pinscher Miniatura medicado com a associação de trimetoprim e sulfadiazina / Pharmacodermia Associated with Systemic Reactions in a Pinscher Dog Treated with Sulfadiazine-trimethoprim / Farmacodermía Asociada a Reacciones Sistémicas en un Perro Pinscher Miniatura Medicado con Asociación de Trimetoprin y Sulfadiazina

Este artigo visa relatar um caso de farmacodermia em um cão da raça Pinscher Miniatura, fêmea de cinco meses de idade. O animal apresentou apatia, anorexia, ceratoconjuntivite seca, hipertermia, desidratação e uma extensa e dolorosa dermatite ulcerativa desde a região cervical até a região lombar. Verificou-se que o animal havia sido medicado com a associação de trimetoprim e sulfadiazina. A dose utilizada do antibiótico era maior que a dose recomendada. Dentre as alterações laboratoriais encontradas observou-se necrose em toda a espessura da epiderme e derme. Apesar da terapia preconizada houve uma rápida deterioração do estado geral do animal, evoluindo para óbito. Para optar-se por uma antibioticoterapia mais segura, deve-se considerar os relatos prévios de reações a fármacos associadas a algumas raças e, além disso, estar atentos à dose terapêutica e à pesagem correta do animal.

ABSTRACT: This article aims in presenting a pharmacodermia case in a fi ve-month-old female Pinscher dog. The animal has shown apathy, anorexia, dry keratoconjunctivitis, and dehydration, extensive and very painful ulcerating dermatitis since the cervical region until the lumbar region. It has been verifi ed that the animal had been treated with trimethoprim-sulfadiazine association. The antibiotic dose used was bigger than the recommended one. Histopathology analysis showed epidermis and dermis necrosis. Despite of the previous therapy, there was a fast deterioration of the general state of the animal ending up to death. To determine a safer antibiotic therapy the veterinarians might consider the previous resumes of the reactions of drugs associated to some races, besides, they have to be aware of the correct dose and the animal's correct weight.

RESUMEN: Este artículo visa relatar un caso de farmacodermía en un perro de la raza Pinscher miniatura, hembra de cinco meses de edad. El animal presentó apatía, anorexia, queratoconjuntivitis seca, hipertermia, desidratación y una extensa y dolorosa dermatitis ulcerativa desde la región cervical hasta la región del espinazo. Se verifi có que el animal había sido medicado con la asociación de trimetoprin y sulfadiazina. La dosis utilizada del antibiótico era mayor que la dosis recomendada. Dentre las alteraciones laboratoriales encontradas se observó necrosis en todo el espesor de la epiderme y derme. A pesar de la terapia preconizada hubo una rápida deterioración de la condición general del animal progresando para óbito. Para optarse por terapia antibiótica con más seguridad, se debe considerar relatos previos de reacciones a fármacos asociados en algunas razas y además, estar atentos a las dosis terapéuticas y al pesaje correcta del animal.

Multicenter evaluation of resistance patterns of Klebsiella pneumoniae, Escherichia coli, Salmonella spp and shigella spp isolated from clinical specimens in Brazil: RESISTNET Surveillance Program

Surveillance programs are essential to detected the increase of antimicrobial resistance, and several different programs are being conducted in many countries. The RESISTNET is a surveillance program for bacterial resistance against several antimicrobial agents initiated in 1998 among Latin American countries. In Brazil, several centers were invited to join this surveillance and a total of 11 centers (6 from Säo Paulo and 5 from other states) participated in the study. All results were analyzed using the WHONET program. A total of 894 Escherichia coli, 386 Klebsiella pneumoniae, 70 Shigella spp and 57 Salmonella spp strains were analyzed in this study from april, 1998, to april, 1999. Susceptibility testing was performed by the disk diffusion method using NCCLS 1998 guidelines for several different drugs. For all strains, imipenem was the most effective drug (100 percent of the strains were susceptible). Klebsiella pneumoniae presented a high resistance rate to ampicillin (96.4 percent). The rate of probable ESBL producers among K. pneumoniae strains was 36.3 percent, most of them being isolated from catheters (58.8 percent). Among all Escherichia coli strains analyzed, the highest resistance rate was found for trimethoprim/sulfamethoxazole (46.9 percent) and the majority of the resistant strains were isolated from urine samples (47.8 percent). Among Salmonella spp, the resistance rates were low for all antibiotics tested. For Shigella spp strains there was a high resistance to trimethoprim/sulfamethoxazole (80.0 percent). No resistance to ceftriaxone was observed in these strains. Surveillance of antimicrobial resistance is critical for the sucessful management of infectious diseases. The results of this survey show significant resistance rates among these bacteria which are responsible for several types of human infections.

Community acquired Pneumonia among pediatric outpatients in Salvador, northeast Brazil, with emphasis on the role of pneumococcus

Pneumonia is one of the leading causes of hospitalization and death among children in developing counties,, and mortality due to pneumoniae has been associated with S. pneumoniae infection. This investigation was designed to describe the antimicrobial susceptibility and serotype patterns of pneumococcal strains recovered from the blood of children with community-acquired pneumonia (CAP) and to acess the clinical findings of pneumococcal bacteremic patients with pneumonia. In a 26 month prospective study, blood cultures were obtained as often as possible from children(<16 years of age) diagnosed with CAP in two emergency rooms. Antimicrobial drug susceptibility tests and serotyping were performed when pneumococcus was identified. We studied 3,431 cases and cultured blood samples from 65.5 percent of those. Pneumococcus was recovered from 0.8 percent of the blood samples. The differences in age, somnolence, wheezing and hospitalization among children with and without pneumococcal bacteremia were statistically significant. Pneumococcal bacteremia was age-related (mean 1.63 +1.55; median 0.92) and associated with somnolence and hospitalization among children with CAP. One strain was recovered from pleural fluid. Penicillin resistance was detected in 21.0 percent(4/19) of the strains at an intermediate level, whereas 63.0 percent of the strains were resistant to trimethoprim-sulfamethoxazole. The most common serotypes were 14 and 6B, and these serotypes included the resistant strains. Eight of our 18 isolates from blood were of types included in the heptavalent conjugate pneumococcal vaccine, recently licensed in the USA.

Otitis en el cantón de Aguirre, Puntarenas, Costa Rica / Otitis in the corner of Aguirre, Puntarenas, Costa Rica

Objetivo: Este trabajo describe las otitis en el cantón de Aguirre desde el 8-3-95 al 9-10-97 así como el tratamiento utilizado. Materiales y métodos: Retrospectivo en 1995 y 1996 y prospectivo en 1997. La identificación de los casos fue en base a los registros de bacteriología y los expedientes del Hospital Max Terán Valls. Se usaron formularios prediseñados. Los médicos generales y pediatras de la zona recolecteron muestras de secreciones del conducto auditivo externo con un isopo, previa limpieza del área con jabón de clorhexidina. Resultados: Se estudiaron un total de 107 casos, 59 por ciento fueron mujeres y 41 por ciento varones. 20.5 por ciento presentó otitis media aguda, 19.6 por ciento otitis crónica y 59.8 por ciento otitis externa. Las infecciones predominaron en Julio y Agosto. Las otitis medias fueron más frecuentes de 1 a 3 años (23.4 por ciento) y de 6 a 9 años (67.2 por ciento), mientras las externas fueron más frecuentes en el grupo preescolar. Se asoció infección de vías respiratorias superiores en un 25.2 por ciento de los casos, faringoamigdalitis 24.3 por ciento y diarrea en 10.2 por ciento. El germen más frecuente en otitis externa fue Pseudomonas sp (50.46 por ciento), mientras que Streptococcus pneumoniae fue el organismo bacteriano más frecuente en las otitis medias (14.95 por ciento). Los principales antibióticos utilizados son: Trimetropín en un 38.3 por ciento, Amoxicilina 23.4 por ciento y la combinación Oxacilina-Amikacina (8.4 por ciento). Conclusiones: La otitis externa es la más frecuente y la pseudomonas sp. es la bacteria más frecuentemente aislada en nuestro medio. Las otitis medias son usualmente virales y cuando se asocia una bacteria, usualmente es el S pneumoniae.

Criptococose retal em um paciente com síndrome da imunodeficiência adquirida / Rectal cryptococcosis in patient with acquired immunodeficiency syndrome

Os autores apresentam o caso de um paciente do sexo masculino, 28 anos, homossexual, portador da síndrome da imunodeficiência adquirida, que vinha apresentando várias internaçöes devido a diarréia crönica. Após realizaçäo de retossigmoidoscopia com biópsia, o exame anatomopatológico evidenciou criptococose retal. Na revisäo de literatura observamos que o cryptodoccus neoformans atinge principalmente sistema nervoso ceentral e pulmöes; menos comumente mucosa oral, pele, esqueleto, pericárdio, miocárdio, músculo, fígado, ,peritönio, adrenais, rins e próstata. Näo há predileçäo por idade, sexo ou profissäo. O fator predisponente mais comum é a imunossupressäo relacionada com alteraçäo da funçäo da célula T. Em pacientes com AIDS a incidência de criptococose varia de 5 porcento a 10 porcento. Na literatura näo encontramos descriçäo ded criptococose retal, especialmente em um caso em que näo há criptococose disseminada.(au)

Emergencia de un nuevo patógeno: Cyclospora cayetanensis en pacientes infectados por el virus de inmunodeficiencia humana / Emergence of a new pathogen: Cyclospora cayetanensis in patients infected with human immunodeficiency virus

The emergence of a new pathogen Cyclospora cayetanensis as a cause of clinical disease in immunosuppressed hosts is related with prolonged, severe and highly recurrent diarrheas. This paper reports two Cuban cases of cyclosporiasis associated with infection from human immunodeficiency virus in which non sporulated oocysts of Cyclospora cayetanensis were detected in feces by modified Zielhl Neelsen's technique. The most significant clinical symptoms were chronic diarrheas and loss of body weight, with CD4 levels below 200 cells per mm3. The occurrence of severe digestive symptoms in patients with Cyclospora cayetanensi and important immune compromise backed up the concept that this pathogen may act as a new opportunistic pathogen in patients with HIV.

Nocardiosis linfocutánea del cuero cabelludo causada por nocardia asteroides: primer caso reportado en la Argentina / Lymphocutaneous nocardiosis of the scalp by nocardia asteroides: report of the first case in Argentina

La nocardiosis es una infección localizada o sistémica de infrecuente observación. En piel puede desarrollar un síndrome linfocutáneo simil esporotricosis. Presentamos un paciente de 61 años que desarrolló nocardiosis linfocutánea por Nocardia asteroides tras un traumatismo menor en cuero cabelludo. En el presente artículo se discuten las formas clínicas de nocardiosis cutáneas. Se realiza una revisión de los casos publicados en nuestro país de nocardiosis linfocutánea, todos provocados por Nocardia brasiliensis y localizados en extremidades. Por lo tanto, comunicamos el primer caso de nocardiosis linfocutánea por Nocardia asteroides en la Argentina