Anetoderma after disseminated Mpox.

Anetoderma or macular atrophy is a rare skin condition of unclear pathogenesis, often associated with autoimmune diseases and skin damage from various infections. Human immunodeficiency virus (HIV), syphilis, and poxviruses have been implicated in the development of anetoderma. A 37-year-old male patient with HIV and recent unprotected sexual encounters presented with more than 400 skin lesions, consistent with Mpox. Symptomatic treatment for Mpox resulted in acute symptom resolution. However, 8 months later he developed papular anetoderma lesions in areas previously affected by Mpox. Biopsy confirmed the loss of elastic fibers in the affected skin areas, leading to the diagnosis of Mpox-induced anetoderma. This report presents a unique case of anetoderma following Mpox in an HIV-positive patient.

Dermoscopy as a diagnostic aid in pityriasis lichenoides et varioliformis acuta.

Diagnosis of pityriasis lichenoides et varioliformis acuta (PLEVA) is based on the characteristic pattern of lesions in different stages of development, ranging from erythematous maculopapules to papules with a crusted and/or necrotic centre. However, it may raise the differential diagnosis with other entities. It is therefore not uncommon to have to perform skin biopsies to reach a diagnosis, including in infants. In this study, we report the cases of three patients with PLEVA, highlighting the correlations between the clinical, dermoscopic and histological features. Observation of the dermatoscopic findings described, such as punctate or glomerular vessels and erythematous globules surrounding a homogeneous orange or crusty central area, may allow for a rapid diagnosis, avoiding the need for invasive techniques.

[Clinical and microbiological characteristics of bloodstream infections in adult neutropenic patients]. / Características clínicas y microbiológicas de infecciones del torrente sanguíneo en pacientes adultos neutropénicos.

Bloodstream infections (BI) are relevant in neutropenic patients because they are associated with an increased number of complications and death. The objective was determinate the epidemiologic and microbiologic features of the BI in neutropenic patients with solid neoplasm (SN) and hematologic neoplasm (HN). Retrospective study in two third level hospitals between 2009 and 2016. They were included all the patients older than 18 years-old with active oncologic disease and neutropenia, who had BI. Patients with dermatologic cancer other than melanoma where excluded. A total of 143 BI in neutropenic were observed, of which 80.4% occurred in HN. Around 97.9% of the patients had a high-risk neutropenia without differences between both groups. The most frequent site of BI was primary bacteremia (46.9%) and catheter-associated infection (21%), without significant differences between the two groups. The gram negatives bacilli (GNB) predominated over the gram positive cocci (GPC) and they represented 74.1% of the isolated bacteria, being Escherichia coli the most frequent (32.8%). Among the gram positive cocci, Staphylococcus aureus (28.1%) was the most frequent isolated, followed by coagulase-negative Staphylococci (CNS). There were no differences in microbiological isolates between both groups. With regard to the antimicrobial susceptibility 67.5% of the CNS, 17.6% of the E. coli and 27.6% of the Klebsiella pneumoniae were multiresistant with no differences between both groups. Only 11.1% of S. aureus isolates were methicillin resistant. In conclusion BI of the neutropenic patients where most frequents within patients with HN, GNB were the main microbiological isolates. High mortality was observed in neutropenic patients with BI.

[Performance of equations to predict cardiovascular risk in an Argentine population]. / Rendimiento de ecuaciones para predecir riesgo cardiovascular en una población argentina.

The performance of available risk scores to predict cardiovascular risk (CVR) in the Argentinian population is unknown. Our aim was to compare the CVR predicted by several equations with the occurrence of cardiovascular events (CVE) in patients without known cardiovascular disease in an Argentinian hospital. Adults between 40 and 70 years were randomly selected, excluding those with prior history of major CVE, active cancer, lipid lowering treatment and absence of follow-up data. Framingham 2008, SCORE (low and high-risk populations), ATP III, World Health Organization- American B region (WHO-B) and Pooled Cohort equations (PC) risk scores were used to calculate 10-y CVR at time of enrollment. End of follow-up was 10 years ± 6 months, occurrence of fatal myocardial infarction or death from any cause. We used ROC curves to assess discrimination (AUC > 0.75 good discrimination), and Hosmer Lemeshow chi-square to evaluate calibration (Chi > 20 or p value < 0.05 poor calibration). We included 606 patients in our study, 336 women, average age 56.7 ± 8.4 year. Of those, 10 (1.7%) non-cardiovascular deaths, and 5 (0.8%) cardiovascular deaths were observed. 58 (9.8%) a non-fatal CVE were recorded. There was acceptable discrimination for Framingham, ATP-III, and both PC equations. The global calibration was only good with the ATP-III and PC equations. The observed frequency of CVE was low, and the CVR was overestimated by all equations. However, applying ATP-III or PC equations to assess CVR could be considered in our population.

El rendimiento de las ecuaciones existentes de predicción de riesgo cardiovascular (RCV) en población argentina es desconocido. Se comparó RCV estimado por dichas ecuaciones, con la ocurrencia de eventos cardiovasculares (ECV) en una población de pacientes sin enfermedad cardiovascular de un hospital argentino. Se incluyeron aleatoriamente adultos entre 40 y 70 años, excluyéndose quienes al momento del enrolamiento presentaban historia de ECV mayor, cáncer activo, o tratamiento hipolipemiante. Se calculó RCV a 10 años al momento de inclusión, utilizando ecuaciones de Framingham 2008, SCORE (para poblaciones de bajo y alto riesgo), ATP III, Organización mundial de la salud- región América B (OMS-B) y Ecuación de Cohorte Agrupada (ECA). El fin de seguimiento fue 10 años ± 6 meses, ocurrencia de infarto de miocardio fatal o muerte por cualquier causa. Se utilizaron curvas ROC para evaluar discriminación (ABC > 0.75 buena discriminación). La calibración se evaluó mediante chi-cuadrado de Hosmer Lemeshow (Chi > 20 o p < 0.05 pobre calibración). Incluimos 606 pacientes, 366 mujeres, edad promedio 56.7 ± 8.4 años. Se observaron 10 (1.7%) muertes de causa no cardiovascular, 5 (0.8%) causa cardiovascular. Se registraron 58 (9.8%) ECV no fatales. Hubo aceptable discriminación para ecuaciones de Framingham, ATP-III y ECA. La calibración global solo fue buena con las ecuaciones de ATP-III y ECA. La frecuencia observada de ECV fue baja, y hubo sobreestimación de RCV con todas las ecuaciones. Sin embargo, se podría sugerir la aplicación de las ecuaciones de ATP-III o ECA en esta población.

[Bloodstream infections in cancer patients]. / Infecciones del torrente sanguíneo en pacientes oncológicos.

Bloodstream infections (BI) are an important cause of morbidity and mortality in cancer patients. A retrospective study was performed in two hospitals aimed to evaluate characteristics of BI episodes occurred in adult patients with hematologic (HN) and solid (SN) neoplasia other than non-melanoma skin cancers in the period 2009-2016. A total of 467 episodes of bacteremia and 16 of fungemia were identified. A total of 200 (41.4%) bacteremias occurred in patients with HN and 283 (58.6%) in patients with SN. The most frequent SN and HN were colon cancer (18.7%) and non-Hodgkin lymphoma (27%), respectively. The main risk factors for BI were a previous surgical procedure in SN and chemotherapy in the previous 30 days and use of central venous catheter in HN. Infections were mainly acquired in the hospital environment and the most frequent presentation was bacteremia without focus, mostly in HN (38% vs. 20.8%, p < 0.001). Gram negative bacilli (GNB) were isolated in 336 (69.5%) episodes and predominated over Gram positive cocci (GPC) in both groups. Escherichia coli was the most frequent GNB isolated in both SN (24.7%) and HN patients (20.5%). The most frequent GPC was Staphylococcus aureus. Multidrug-resistance was found in 15% of the isolates in SN and 18% in HN. The overall mortality was 40.5% in patients with HN and 37.5% in patients with SN, with the majority of deaths occurring in the first 30 days.

Las infecciones del torrente sanguíneo (ITS) son una importante causa de morbimortalidad en pacientes oncológicos. Los objetivos del estudio fueron evaluar las características de las ITS en pacientes con neoplasia hematológica (NH) y sólida (NS) en un estudio retrospectivo realizado en dos hospitales, entre 2009 y 2016. Fueron incluidos todos los episodios de ITS en adultos con neoplasias activas, excepto cáncer de piel no melanoma. Fueron identificados 467 episodios de bacteriemia y 16 de fungemia. Un total de 200 (41.4%) bacteriemias ocurrieron en pacientes con NH y 283 (58.6%) en pacientes con NS. Las NS y NH más frecuentes fueron cáncer de colon (18.7%) y linfoma no Hodgkin (27%), respectivamente. Los principales factores de riesgo de ITS fueron el antecedente de procedimiento quirúrgico para NS y quimioterapia en los 30 días previos y uso de catéter venoso central para NH. Las infecciones fueron adquiridas principalmente en el medio intrahospitalario y la presentación más frecuente fue la bacteriemia sin foco, fundamentalmente en NH (38.0% vs. 20.8%, p < 0.001). En un total de 336 (69.5%) aislamientos predominaron bacilos Gram negativos (BGN) sobre cocos Gram positivos (CGP) sin diferencias entre grupos. Escherichia coli fue el BGN más frecuente en NS (24.7%) y NH (20.5%). El CGP más frecuente fue Staphylococcus aureus. El 15% y el 18% de los aislamientos fue multirresistente en NS y NH, respectivamente. La mortalidad global fue 40.5% en pacientes con NH y 37.5% en pacientes con NS. La mayoría de las muertes ocurrió en los primeros 30 días.

[Epidemiological and microbiological characteristics of uncomplicated urinary infections]. / Características epidemiológicas y microbiológicas de las infecciones urinarias no complicadas.

Introduction: Uncomplicated urinary tract infections(UC-UTI) represent a frequent reason for consultation. Most cases are empirically treated, but the antimicrobial susceptibility of the causative microorganisms has changed over the past years. The objectives of this study where to determine UC-UTI causative microorganism and their antimicrobial susceptibility profiles in adult women. Methods: A prospective analytic study was conducted in two hospital in Córdoba, Argentina, between November/2016 and October/2017. From the identification of positive urine cultures, urinary tract infections (UTI) in women ≥18 years without risk factors for complicated UTIs were included, excluding asymptomatic bacteriurias. Results: A total of 610 UC-UTI were identified and 62.6% of them in patients younger than 50 years; 73.3% of cases were cystitis, being more frequent in older women. Escherichia coli was isolated in 89.2% of UTI and negative coagulase Staphylococcus in 4.2%. As regards Escherichia coli, its resistance against ciprofloxacin was 18.8%; 4.4% against ceftriaxone and 1.8% against nitrofurantoin. There was an elevated resistance against ampicillin, trimethoprim­sulfamethoxazole and ampicillin­sulbactam. Main conclusion: The most frequent isolated microorganism was Escherichia coli, consistent with global epidemiology. This microorganism showed less than 20% total resistance against ciprofloxacin, ceftriaxone and nitrofurantoin.

Introducción: Las infecciones del tracto urinario no complicadas (ITU-NoC) representan un motivo frecuente de consulta ambulatorio, siendo la mayoría tratadas empíricamente. Han existido cambios en susceptibilidad antimicrobiana en los últimos años. Nuestros objetivos fueron determinar los microorganismos de las ITU-NoC y su perfil de susceptibilidad antimicrobiana en mujeres adultas. Métodos: Estudio analítico prospectivo en dos hospitales de Córdoba, Argentina, entre noviembre/2016 y octubre/2017. A partir de la identificación de urocultivos positivos, se incluyeron las infecciones urinarias(ITUs) en mujeres ≥18 años, sin factores de riesgo para ITUs complicada, excluyéndose las bacteriurias asintomáticas. Resultados: Se identificaron 610 episodios de ITU-NoC, 382(63%) en <50 años. El 73.3% de las ITU-noC correspondieron a cistitis, siendo más frecuentes en las mujeres mayores 50 años.  En el 89.2% de las ITUs se aisló Escherichia coli y 4.2% Staphylococcus coagulasa negativo. Respecto a E. coli, su resistencia a ciprofloxacina fue de 18.8%, ceftriaxona 4.4% y nitrofurantoína 1.8%. Se observó una resistencia elevada a ampicilina, trimetoprima-sulfametoxazol y ampicilina-sulbactam. Conclusiones: En conclusión, el microorganismo más frecuentemente aislado fue E. coli, concordando con la epidemiología global, presentando una resistencia menor al 20% a ciprofloxacina, ceftriaxona y nitrofurantoína.

Urinary tract infections in hospitalized patients.

INTRODUCTION: Urinary Tract Infections (UTI) are an important cause of morbidity in the community, constituting one of the main reasons for hospitalization, and the fourth cause of healthcare-associated infection. The objectives of this study were to determine the frequency of community-acquired UTI (CA-UTI) with need of hospitalization and healthcare-associated UTI (HA-UTI), their risk factors, etiologic agents and their antimicrobial susceptibility spectrum. METHODS: A prospective and analytic study was conducted, in which all admissions regarding CA-UTI with need of hospitalization and HA-UTI were evaluated during the period between 2016 and 2017 in two university hospitals. RESULTS: A total of 279 episodes of UTI in hospitalized patients were identified and, among those, 178 episodes corresponded to CA-UTI and 101 to HA-UTI. On average, patients were 60 years old in both groups. HA-UTI were more frequently associated with kidney transplant, recurrent UTI and chronic kidney disease compared with CA-UTI. The instrumentation of urinary tract within the previous month was more frequent in HA-UTI (75.2% vs 32.6%, p<0.001). Escherichia coli was the most frequent isolated microorganism (62.9% in CA-UTI and 56.4% in HA-UTI), followed by Klebsiella pneumoniae and Pseudomonas aeruginosa. A total of 101 multidrug resistant microorganisms were isolated, of which 53.5% were CA-UTI, and were associated with male patients, use of antimicrobials within the previous three months, chronic kidney disease and recurrent UTI. CONCLUSION: It is of great importance for the institutions to identify the local antimicrobial susceptibility spectrum of UTI in order to stablish adequate empiric treatments.

Rendimiento de ecuaciones para predecir riesgo cardiovascular en una población de Argentina / Performance of equations to predict cardiovascular risk in an Argentine population

Resumen El rendimiento de las ecuaciones existentes de predicción de riesgo cardiovascular (RCV) en población argentina es desconocido. Se comparó RCV estimado por dichas ecuaciones, con la ocurrencia de eventos cardiovasculares (ECV) en una población de pacientes sin enfermedad cardiovascular de un hospital argentino. Se incluyeron aleatoriamente adultos entre 40 y 70 años, excluyéndose quienes al momento del enrolamiento presentaban historia de ECV mayor, cáncer activo, o tratamiento hipolipemiante. Se calculó RCV a 10 años al momento de inclusión, utilizando ecuaciones de Framingham 2008, SCORE (para poblaciones de bajo y alto riesgo), ATP III, Organización mundial de la saludregión América B (OMS-B) y Ecuación de Cohorte Agrupada (ECA). El fin de seguimiento fue 10 años ± 6 meses, ocurrencia de infarto de miocardio fatal o muerte por cualquier causa. Se utilizaron curvas ROC para evaluar discriminación (ABC > 0.75 buena discriminación). La calibración se evaluó mediante chi-cuadrado de Hosmer Lemeshow (Chi > 20 o p < 0.05 pobre calibración). Incluimos 606 pacientes, 366 mujeres, edad promedio 56.7 ± 8.4 años. Se observaron 10 (1.7%) muertes de causa no cardiovascular, 5 (0.8%) causa cardiovascular. Se registraron 58 (9.8%) ECV no fatales. Hubo aceptable discriminación para ecuaciones de Framingham, ATP-III y ECA. La calibración global solo fue buena con las ecuaciones de ATP-III y ECA. La frecuencia observada de ECV fue baja, y hubo sobreestimación de RCV con todas las ecuaciones. Sin embargo, se podría sugerir la aplicación de las ecuaciones de ATP-III o ECA en esta población.

Abstract The performance of available risk scores to predict cardiovascular risk (CVR) in the Argentinian population is unknown. Our aim was to compare the CVR predicted by several equations with the occurrence of cardiovascular events (CVE) in patients without known cardiovascular disease in an Argentinian hospital. Adults between 40 and 70 years were randomly selected, excluding those with prior history of major CVE, active cancer, lipid lowering treatment and absence of follow-up data. Framingham 2008, SCORE (low and high-risk populations), ATP III, World Health OrganizationAmerican B region (WHO-B) and Pooled Cohort equations (PC) risk scores were used to calculate 10-y CVR at time of enrollment. End of follow-up was 10 years ± 6 months, occurrence of fatal myocardial infarction or death from any cause. We used ROC curves to assess discrimination (AUC > 0.75 good discrimination), and Hosmer Lemeshow chi-square to evaluate calibration (Chi > 20 or p value < 0.05 poor calibration). We included 606 patients in our study, 336 women, average age 56.7 ± 8.4 year. Of those, 10 (1.7%) non-cardiovascular deaths, and 5 (0.8%) cardiovascular deaths were observed. 58 (9.8%) a non-fatal CVE were recorded. There was acceptable discrimination for Framingham, ATP-III, and both PC equations. The global calibration was only good with the ATP-III and PC equations. The observed frequency of CVE was low, and the CVR was overestimated by all equations. However, applying ATP-III or PC equations to assess CVR could be considered in our population.

Características clínicas y microbiológicas de infecciones del torrente sanguíneo en pacientes adultos neutropénicos / Clinical and microbiological characteristics of bloodstream infections in adult neutropenic patients

RESUMEN Las infecciones del torrente sanguíneo (IS) en pacientes oncológicos neutropénicos constituyen una patología de relevancia y se asocian a un aumento de la morbimortalidad. El objetivo de este estudio fue determinar las características epidemiológicas y microbiológicas de los episodios de IS en pacientes adultos neutropénicos con neoplasias hematológicas (NH) y neoplasias sólidas (NS). Se realizó un estudio retrospectivo en dos hospitales de tercer nivel entre 2009 y 2016. Se incluyeron todos los pacientes neutropénicos mayores de 18años con NH y NS que presentaron episodios de IS. Se excluyeron aquellos con neoplasias dermatológicas no melanoma. Se identificaron 143 episodios de IS, de los cuales el 80,4% fueron en personas con NH. El 97,9% de los pacientes tuvieron neutropenia de alto riesgo, sin diferencia entre los grupos NH y NS. Los orígenes más frecuentes de IS fueron bacteriemia primaria (46,9%) e infección asociada a catéter (21%), sin diferencias significativas entre grupos. El 74,1% de los aislamientos fueron bacilos gram negativos yEscherichiacolifue el microorganismo más frecuente (32,1%). El coco gram positivo más frecuentemente aislado fueStaphylococcusaureus(28,1%), seguido del grupo de los estafilococos coagulasa negativos (ECN), sin diferencias entre ambos tipos de neoplasias. El 67,5% de los ECN fueron multirresistentes; solo el 11,1% de los aislamientos deS. aureusfue resistente a la meticilina. El 17,6% de los aislamientos deE. coliy el 27,6% de los deKlebsiellapneumoniaefueron multirresistentes. No hubo diferencias en la frecuencia de aislamientos multirresistentes al comparar entre ambos tipos de neoplasia. Como conclusión, las IS en pacientes neutropénicos fueron más frecuentes en pacientes con NH y las causaron, principalmente, bacilos gram negativos. Se observó una elevada mortalidad en los pacientes neutropénicos con IS.

ABSTRACT Bloodstream infections (BI) are relevant in neutropenic patients because they are associated with an increased number of complications and death. The objective was determinate the epidemiologic and microbiologic features of the BI in neutropenic patients with solid neoplasm (SN) and hematologic neoplasm (HN). Retrospective study in two third level hospitals between 2009 and 2016. They were included all the patients older than 18 years-old with active oncologic disease and neutropenia, who had BI. Patients with dermatologic cancer other than melanoma where excluded. A total of 143 BI in neutropenic were observed, of which 80.4% occurred in HN. Around 97.9% of the patients had a high-risk neutropenia without differences between both groups. The most frequent site of BI was primary bacteremia (46.9%) and catheter-associated infection (21%), without significant differences between the two groups. The gram negatives bacilli (GNB) predominated over the gram positive cocci (GPC) and they represented 74.1% of the isolated bacteria, beingEscherichia colithe most frequent (32.8%). Among the gram positive cocci,Staphylococcus aureus(28.1%) was the most frequent isolated, followed by coagulase-negativeStaphylococci(CNS). There were no differences in microbiological isolates between both groups. With regard to the antimicrobial susceptibility 67.5% of the CNS, 17.6% of theE. coliand 27.6% of theKlebsiella pneumoniaewere multiresistant with no differences between both groups. Only 11.1% of S. aureus isolates were methicillin resistant. In conclusion BI of the neutropenic patients where most frequents within patients with HN, GNB were the main microbiological isolates. High mortality was observed in neutropenic patients with BI.

Bloodstream infections in cancer patients / Artículo original

Resumen Las infecciones del torrente sanguíneo (ITS) son una importante causa de morbimortalidad en pacientes oncológicos. Los objetivos del estudio fueron evaluar las características de las ITS en pacientes con neoplasia hematológica (NH) y sólida (NS) en un estudio retrospectivo realizado en dos hospitales, entre 2009 y 2016. Fueron incluidos todos los episodios de ITS en adultos con neoplasias activas, excepto cáncer de piel no melanoma. Fueron identificados 467 episodios de bacteriemia y 16 de fungemia. Un total de 200 (41.4%) bacteriemias ocurrieron en pacientes con NH y 283 (58.6%) en pacientes con NS. Las NS y NH más frecuentes fueron cáncer de colon (18.7%) y linfoma no Hodgkin (27%), respectivamente. Los principales factores de riesgo de ITS fueron el antecedente de procedimiento quirúrgico para NS y quimioterapia en los 30 días previos y uso de catéter venoso central para NH. Las infecciones fueron adquiridas principalmente en el medio intrahospitalario y la presentación más frecuente fue la bacteriemia sin foco, fundamentalmente en NH (38.0% vs. 20.8%, p < 0.001). En un total de 336 (69.5%) aislamientos predominaron bacilos Gram negativos (BGN) sobre cocos Gram positivos (CGP) sin diferencias entre grupos. Escherichia coli fue el BGN más frecuente en NS (24.7%) y NH (20.5%). El CGP más frecuente fue Staphylococcus aureus. El 15% y el 18% de los aislamientos fue multirresistente en NS y NH, respectivamente. La mortalidad global fue 40.5% en pacientes con NH y 37.5% en pacientes con NS. La mayoría de las muertes ocurrió en los primeros 30 días.

Abstract Bloodstream infections (BI) are an important cause of morbidity and mortality in cancer patients. A retrospective study was performed in two hospitals aimed to evaluate characteristics of BI episodes occurred in adult patients with hematologic (HN) and solid (SN) neoplasia other than non-melanoma skin cancers in the period 2009-2016. A total of 467 episodes of bacteremia and 16 of fungemia were identified. A total of 200 (41.4%) bacteremias occurred in patients with HN and 283 (58.6%) in patients with SN. The most frequent SN and HN were colon cancer (18.7%) and non-Hodgkin lymphoma (27%), respectively. The main risk factors for BI were a previous surgical procedure in SN and chemotherapy in the previous 30 days and use of central venous catheter in HN. Infections were mainly acquired in the hospital environment and the most frequent presentation was bacteremia without focus, mostly in HN (38% vs. 20.8%, p < 0.001). Gram negative bacilli (GNB) were isolated in 336 (69.5%) episodes and predominated over Gram positive cocci (GPC) in both groups. Escherichia coli was the most frequent GNB isolated in both SN (24.7%) and HN patients (20.5%). The most frequent GPC was Staphylococcus aureus. Multidrug-resistance was found in 15% of the isolates in SN and 18% in HN. The overall mortality was 40.5% in patients with HN and 37.5% in patients with SN, with the majority of deaths occurring in the first 30 days.