Prevalence and etiology of onychomycosis in the HIV-infected Mexican population.

Onychomycosis is a fungal infection of the nail caused by dermatophytes, yeasts, and non-dermatophyte molds. Human immunodeficiency virus (HIV)-infected patients are predisposed to this infection. In a cross-sectional study, we estimated the prevalence of onychomycosis and the frequency of fungal agents among HIV-infected patients in Mexico. We enrolled HIV-infected patients diagnosed clinically with onychomycosis from 2008 to 2010. Samples were collected from 300 (84% men) HIV-positive patients by scraping of subungual hyperkeratotic debris and nail plate clipping. All specimens were subjected to culture on Sabouraud agar, Mycosel™ agar, direct microscopy with potassium hydroxide (KOH) and the cultures were incubated at 35 °C for 4 weeks. The prevalence and the 95% binomial confidence intervals were calculated. The mean age (± SD) was 37 ± 9 years. One hundred and twenty-four patients (41%) had clinical signs of onychomycosis and 51 (17%) produced a positive culture. Candida parapsilosis was the most frequently isolated microorganism (13 patients, 20%), followed by Trichophyton rubrum (11 patients, 17%).

[Pro-inflammatory cytokines related to severity and mortality in type 2 diabetes patients with soft tissue infection]. / Citocinas, diabetes e infección de tejidos blandos. Su relación con la severidad y mortalidad.

OBJECTIVE: to determine the relation between IL6, IL10 and TNFa serum levels in a cohort of patients with type 2 diabetes (T2D) and severe soft tissue infections (STI), with severity and mortality factors. METHODS: A. comparative and transversal, study with 15 adult patients, any gender, with T2D and STI were done. A T2D control group of 20 patients without STI was included. Apache II Score, glycemia and by ELISA, IL6, IL10 and TNFa, were determined. RESULTS: in all patients, it was a correlation at beginning between glycemia and IL6 (r = 0.67, IC 95 % 0.24-0.88), as soon as glycemia and Apache II, (r = 0.59, IC 95 % 0.11-0.83). CONCLUSIONS: although IL6 was very usefulness, it is not a routine test in clinical laboratory and it is expensive, but in medical practice, it could be possible to evaluate these patients with Apache II Score and glycemia. However, in STI, the values of IL6 and IL10 were highly significant. It is likely that IL6 is a marker of poor outcome.

Prevalence and resistance pattern of genotype G and H in chronic hepatitis B and HIV co-infected patients in Mexico.

OBJECTIVE: We estimated the prevalence and identified the resistance pattern of HBV genotypes H and G in HBV monoinfected and HIV co-infected patients. MATERIAL AND METHODS: A cross-sectional prevalence and analytic study were performed in chronic hepatitis B patients at the Hospital de Infectología, La Raza National Medical Center in Mexico City. Chronic HBV monoinfected and HIV co-infected patients were included. HBeAg, HBV viral load and genetic analysis of mutations were collected; CD4+ cells count from HIV co-infected patients and HIV RNA were measured. We calculated the prevalence and exact 95% binomial confidence interval and the Odds ratios (OR) with 95% confidence intervals to assess the relationship between the presence of risk factors and HBV genotypes H or G. RESULTS: We enrolled 77 patients, 67 men and 10 women with 37 HIV co-infected patients. The distribution of HBV genotypes was: HBV genotype H 55 (71% [95% CI 60% to 80%]), HBV genotype G 16 (20.7%), HBV genotype F 4 (5.1%) and HBV genotype A 2 (2.6%). The most frequent mutations presented in 8 HIV co-infected patients and one mono-infected patient with antiretroviral therapy (ART) experience were rtM204V and six of them showed genotype G (6/9). Mono-infected HBV patients exposed more probability to HBV genotype H than co-infected HIV patients OR 13.0 (CI 95% 3.40-49.79), p = 0.0001. In contrast co-infected patients presented less possibility to have genotype H, 0.56 (CI 95% 0.42-0.75). CONCLUSIONS: This study confirms the high prevalence of HBV genotype H in Mexico; furthermore, our results suggest that HBV genotype G predominates in co-infected patients. As well, rtM204V and rtL180M mutations are common in HBV-HIV co-infected patients with genotype G and ART experience.

[Prevalence of bacterial infections and patterns of bacterial susceptibility among patients with fever, neutropenia, and hematological neoplasias]. / Patrones de susceptibilidad bacteriana en infecciones en pacientes adultos con neoplasias hematológicas, fiebre y neutropenia.

Chemotherapy induces immunosuppression which is associated with a significant increase in the frequency and severity of infections. Neutropenia is the most important factor in determining susceptibility to bacterial infections. Our aim was to establish the prevalence of bacterial infections and bacterial susceptibility patterns in patients with fever, neutropenia and hematological neoplasias. Cultures were obtained prior empirical antimicrobial treatment. Susceptibility tests to antibiotics were performed for all microorganisms considered pathogens. Descriptive statistics were used for each variable. Differences between proportions were estimated by means of χ2 or Fisher's exact test. We included 85 patients.Primary bacteremia was the most frequent cause of fever (52%). Microorganisms most frequently isolated were:S. epidermidis (54.2%), E. coli (12.5%), S. aureus (8.3%). In susceptibility tests 88.5% of S. epidermidis strains were resistant to oxaciline (MIC > 8 µ/ml); E. coli was resistant to ceftazidime (50%) and trimethroprim/sulfamethoxazole (83%).In conclusion, gram-positive microorganisms are predominant in patients with fever and neutropenia followed by gram-negatives like E. coli. Predominance of gram-positives microorganism forces us to reconsider our current prophylactic and therapeutic antimicrobials regimens used in these patients.

Correlation between HIV viral load and aminotransferases as liver damage markers in HIV infected naive patients: a concordance cross-sectional study.

Abnormalities in liver function tests could be produced exclusively by direct inflammation in hepatocytes, caused by the human immunodeficiency virus (HIV). Mechanisms by which HIV causes hepatic damage are still unknown. Our aim was to determine the correlation between HIV viral load, and serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) as markers of hepatic damage in HIV naive infected patients. We performed a concordance cross-sectional study. Patients with antiviral treatment experience, hepatotoxic drugs use or co-infection were excluded. We used a Pearson's correlation coefficient to calculate the correlation between aminotransferases serum levels with HIV viral load. We enrolled 59 patients, 50 men and 9 women seen from 2006 to 2008. The mean (+/- SD) age of our subjects was 34.24 +/- 9.5, AST 37.73 +/- 29.94 IU/mL, ALT 43.34 +/- 42.41 IU/mL, HIV viral load 199,243 +/- 292,905 copies/mL, and CD4+ cells count 361 +/- 289 cells/mm(3). There was a moderately strong, positive correlation between AST serum levels and HIV viral load (r = 0.439, P < 0.001); and a weak correlation between ALT serum levels and HIV viral load (r = 0.276, P = 0.034); after adjusting the confounders in lineal regression model the correlation remained significant. Our results suggest that there is an association between HIV viral load and aminotransferases as markers of hepatic damage; we should improved recognition, diagnosis and potential therapy of hepatic damage in HIV infected patients.

Within-host population dynamics of antibiotic-resistant M. tuberculosis.

Mathematical models for the population dynamics of de novo resistant Mycobacterium tuberculosis within individuals are studied. The models address the use of one or two antimicrobial drugs for treating latent tuberculosis (TB). They consider the effect of varying individual immune response strength on the dynamics for the appearance of resistant bacteria. From the analysis of the models, equilibria and local stabilities are determined. For assessing temporal dynamics and global stability for sensitive and drug-resistant bacteria, numerical simulations are used. Results indicate that for a low bacteria load that is characteristic of latent TB and for small reduction in an immune response, the use of a single drug is capable of curing the infection before the appearance of drug resistance. However, for severe immune deficiency, the use of two drugs will provide a larger time period before the emergence of resistance. Therefore, in this case, two-drugs treatment will be more efficient in controlling the infection.