Listeria bacteremia in patients from a peruvian oncologic institute, 2005-2015. / Bacteriemia por listeria en pacientes de un instituto oncológico peruano, 2005-2015.

Listeriosis infection is a severe disease, with high morbidity and mortality in the immunocompromised patient, especially with disseminated and fatal presentations in cancer patients. A descriptive study was developed to describe the clinical and epidemiologic characteristics in oncologic patients with listeriosis in the Instituto Nacional de Enfermedades Neoplásicas between the years 2005-2015. A total of 29 patients were included; 23 (79.3%) of the listeriosis cases showed up in patients with hematological neoplasia, of which 52.1% was acute lymphatic leukemia and 39.1% non-Hodgkin's lymphoma. The 72.4% of the isolated species correspond to Listeria monocytogenes. Twenty-seven (93.1%) patients met sepsis criteria and twenty-four (82.7%) had neurologic affection. Bacteremia was the most common presentation, followed by meningoencephalitis (20.6%). Global mortality was 75.8%. In conclusion in cancer patients, listeriosis implies high morbidity and mortality. Therefore, the suspicion of this entity is mandatory in onco-hematologic patients with sepsis and acute neurologic symptoms.

La listeriosis es una infección severa de elevada morbimortalidad en el paciente inmunocomprometido, existen formas diseminadas y fatales en el paciente oncológico. Se realizó un estudio descriptivo de las características clínico-epidemiológicas de los pacientes oncológicos con listeriosis atendidos en el Instituto Nacional de Enfermedades Neoplásicas entre 2005 y 2015. Se incluyeron 29 pacientes, 23 (79,3%) casos de listeriosis se presentaron en pacientes con neoplasia hematológica, de los cuales el 52,3% fueron leucemia linfática aguda y 39,1% linfoma no Hodgkin. Listeria monocytogenes representó el 72,4% de las especies aisladas. Veintisiete (93,1%) tuvieron criterios de sepsis y veinticuatro (82,7%) compromiso neurológico al ingreso. La presentación más común fue la bacteriemia, seguida de la meningoencefalitis (20,6%). La mortalidad global fue del 75,8%. Se concluye que la listeriosis conlleva elevada morbimortalidad en el paciente oncohematológico, por lo que debe sospecharse en el paciente admitido con sepsis y/o compromiso neurológico agudo.

First Report of New Delhi Metallo-ß-Lactamase Carbapenemase-Producing Acinetobacter baumannii in Peru.

Here we report the first incidence of New Delhi metallo-ß-lactamase (NDM-1)-producing Acinetobacter baumannii in Peru, identified via a strain-based nosocomial surveillance project carried out in Lima and Iquitos. The bla NDM-1 gene was detected by multiplex polymerase chain reaction (PCR) and confirmed by loci sequencing. Acinetobacter baumannii is a nearly ubiquitous and promiscuous nosocomial pathogen, and the acquisition of bla NDM-1 by A. baumannii may facilitate an increase in the prevalence of this important resistance marker in other nosocomial pathogens.

[Tuberculosis That Mimics Cancer: Cases Referred to the National Institute of Neoplastic Diseases, Lima-Peru]. / Tuberculosis que imita cáncer: casos derivados al Instituto Nacional de Enfermedades Neoplásicas, Lima-Perú.

Tuberculosis (TB) is a major public health problem that, due to the clinical variability of its presentation, can be confused with cancer. The aim of this study was to identify the clinical-radiological characteristics and to describe the methodology that allowed to achieve a TB diagnosis in patients referred to the National Institute of Neoplastic Diseases (INEN) with a presumed diagnosis of cancer between 2014 and 2016. The study included 170 patients (52.4% men) with an average age of 41.1 years; 18% presented a history of contact with TB, and 5.9% had had the disease previously. The TB was pulmonary in 22.4% and extrapulmonary in 77.7% of patients. The most frequent symptoms were respiratory, tumor, weight loss, and neurological. The cancer diagnoses most frequently discarded were lymphoma, lung cancer, and brain cancer. The lesions that suggested a neoplasm indicated an advanced clinical stage in 63.5%. Therefore, it follows that the symptoms and images associated with TB can be confused with malignant neoplasms.

La tuberculosis (TB) es un importante problema de salud pública que debido a la variabilidad clínica de su presentación, puede confundirse con una malignidad. El objetivo del estudio fue identificar las características clínico radiológicas y describir la metodología que permitió llegar al diagnóstico de TB en pacientes derivados con presunción diagnóstica de cáncer al Instituto Nacional de Enfermedades Neoplásicas (INEN) entre 2014 y 2016. Se incluyeron 170 pacientes (52,4 % hombres) con edad promedio de 41,1 años, 18 % presentaron antecedentes de contacto con TB y un 5,9 % tuvo previamente la enfermedad. La TB fue pulmonar en 22,4 % y extrapulmonar en 77,7 % de los pacientes. Los síntomas más frecuentes fueron respiratorios, tumoración, pérdida de peso y neurológicos. Los diagnósticos oncológicos descartados con mayor frecuencia fueron linfoma, cáncer pulmonar y cerebral. Las lesiones que sugerían una neoplasia indicaron un estadio clínico avanzado en el 63,5 %. Se concluye que los síntomas e imágenes asociados a TB pueden confundirse con neoplasias malignas.

Bacteriemia por listeria en pacientes de un instituto oncológico peruano, 2005-2015 / Listeria bacteremia in patients from a peruvian oncologic institute, 2005-2015

RESUMEN La listeriosis es una infección severa de elevada morbimortalidad en el paciente inmunocomprometido, existen formas diseminadas y fatales en el paciente oncológico. Se realizó un estudio descriptivo de las características clínico-epidemiológicas de los pacientes oncológicos con listeriosis atendidos en el Instituto Nacional de Enfermedades Neoplásicas entre 2005 y 2015. Se incluyeron 29 pacientes, 23 (79,3%) casos de listeriosis se presentaron en pacientes con neoplasia hematológica, de los cuales el 52,3% fueron leucemia linfática aguda y 39,1% linfoma no Hodgkin. Listeria monocytogenes representó el 72,4% de las especies aisladas. Veintisiete (93,1%) tuvieron criterios de sepsis y veinticuatro (82,7%) compromiso neurológico al ingreso. La presentación más común fue la bacteriemia, seguida de la meningoencefalitis (20,6%). La mortalidad global fue del 75,8%. Se concluye que la listeriosis conlleva elevada morbimortalidad en el paciente oncohematológico, por lo que debe sospecharse en el paciente admitido con sepsis y/o compromiso neurológico agudo.

ABSTRACT Listeriosis infection is a severe disease, with high morbidity and mortality in the immunocompromised patient, especially with disseminated and fatal presentations in cancer patients. A descriptive study was developed to describe the clinical and epidemiologic characteristics in oncologic patients with listeriosis in the Instituto Nacional de Enfermedades Neoplásicas between the years 2005-2015. A total of 29 patients were included; 23 (79.3%) of the listeriosis cases showed up in patients with hematological neoplasia, of which 52.1% was acute lymphatic leukemia and 39.1% non-Hodgkin's lymphoma. The 72.4% of the isolated species correspond to Listeria monocytogenes. Twenty-seven (93.1%) patients met sepsis criteria and twenty-four (82.7%) had neurologic affection. Bacteremia was the most common presentation, followed by meningoencephalitis (20.6%). Global mortality was 75.8%. In conclusion in cancer patients, listeriosis implies high morbidity and mortality. Therefore, the suspicion of this entity is mandatory in onco-hematologic patients with sepsis and acute neurologic symptoms.

Bacteriemia por listeria en pacientes de un instituto oncológico peruano, 2005-2015 / Listeria bacteremia in patients from a peruvian oncologic institute, 2005-2015

RESUMEN La listeriosis es una infección severa de elevada morbimortalidad en el paciente inmunocomprometido, existen formas diseminadas y fatales en el paciente oncológico. Se realizó un estudio descriptivo de las características clínico-epidemiológicas de los pacientes oncológicos con listeriosis atendidos en el Instituto Nacional de Enfermedades Neoplásicas entre 2005 y 2015. Se incluyeron 29 pacientes, 23 (79,3%) casos de listeriosis se presentaron en pacientes con neoplasia hematológica, de los cuales el 52,3% fueron leucemia linfática aguda y 39,1% linfoma no Hodgkin. Listeria monocytogenes representó el 72,4% de las especies aisladas. Veintisiete (93,1%) tuvieron criterios de sepsis y veinticuatro (82,7%) compromiso neurológico al ingreso. La presentación más común fue la bacteriemia, seguida de la meningoencefalitis (20,6%). La mortalidad global fue del 75,8%. Se concluye que la listeriosis conlleva elevada morbimortalidad en el paciente oncohematológico, por lo que debe sospecharse en el paciente admitido con sepsis y/o compromiso neurológico agudo.

ABSTRACT Listeriosis infection is a severe disease, with high morbidity and mortality in the immunocompromised patient, especially with disseminated and fatal presentations in cancer patients. A descriptive study was developed to describe the clinical and epidemiologic characteristics in oncologic patients with listeriosis in the Instituto Nacional de Enfermedades Neoplásicas between the years 2005-2015. A total of 29 patients were included; 23 (79.3%) of the listeriosis cases showed up in patients with hematological neoplasia, of which 52.1% was acute lymphatic leukemia and 39.1% non-Hodgkin's lymphoma. The 72.4% of the isolated species correspond to Listeria monocytogenes. Twenty-seven (93.1%) patients met sepsis criteria and twenty-four (82.7%) had neurologic affection. Bacteremia was the most common presentation, followed by meningoencephalitis (20.6%). Global mortality was 75.8%. In conclusion in cancer patients, listeriosis implies high morbidity and mortality. Therefore, the suspicion of this entity is mandatory in onco-hematologic patients with sepsis and acute neurologic symptoms.

Building a three-dimensional model of the upper gastrointestinal tract for computer simulations of swallowing.

We aimed to provide realistic three-dimensional (3D) models to be used in numerical simulations of peristaltic flow in patients exhibiting difficulty in swallowing, also known as dysphagia. To this end, a 3D model of the upper gastrointestinal tract was built from the color cryosection images of the Visible Human Project dataset. Regional color heterogeneities were corrected by centering local histograms of the image difference between slices. A voxel-based model was generated by stacking contours from the color images. A triangle mesh was built, smoothed and simplified. Visualization tools were developed for browsing the model at different stages and for virtual endoscopy navigation. As result, a computer model of the esophagus and the stomach was obtained, mainly for modeling swallowing disorders. A central-axis curve was also obtained for virtual navigation and to replicate conditions relevant to swallowing disorders modeling. We show renderings of the model and discuss its use for simulating swallowing as a function of bolus rheological properties. The information obtained from simulation studies with our model could be useful for physicians in selecting the correct nutritional emulsions for patients with dysphagia.

[Clinical features and toxicity of tuberculosis treatment in patients with cancer]. / Características clínicas y toxicidad del tratamiento de tuberculosis en pacientes con cáncer.

OBJECTIVES: To assess the clinical and epidemiological characteristics of active tuberculosis in patients with malignancy and to assess the influence of TB treatment on cancer management at the National Institute of Neoplastic Diseases from 2008 to 2013. MATERIALS AND METHODS: Observational study of TB cases diagnosed by positive sputum microscopy in patients with cancer. Clinical information, evolution, and pathologic information of neoplasia was reviewed. RESULTS: 76 cases of active tuberculosis after being diagnosed with cancer were found. The median age was 51.3 years. Median follow-up was 2.1 years. The most common cancers were acute lymphocytic leukemia (14.5%), for the hematologic cancers; and cancer of the cervix (14.5%), breast (10.5%), and gastric (7.9%) for non-hematological cancers. 27.6% of patients had recurrence of the tumor; TB diagnosis confounded the initial staging by 6.9% and was initially stated as cancer recurrence in 11.1% (breast and colon cancers). The diagnosis of tuberculosis delayed or influenced the dose reduction of the antineoplastic treatment in 11.1% of the cases (acute lymphocytic leukemia and non-Hodgkin lymphoma). 8.3% of patients had toxicity to the TB treatment. CONCLUSIONS: Cancer patients may have active tuberculosis infection. The interference effect of diagnosis and treatment of tuberculosis on the assessment of cancer and cancer treatment in our series is minimal.

Tuberculosis que imita cáncer: casos derivados al Instituto Nacional de Enfermedades Neoplásicas, Lima-Perú / Tuberculosis That Mimics Cancer: Cases Referred to the National Institute of Neoplastic Diseases, Lima-Peru

RESUMEN La tuberculosis (TB) es un importante problema de salud pública que debido a la variabilidad clínica de su presentación, puede confundirse con una malignidad. El objetivo del estudio fue identificar las características clínico radiológicas y describir la metodología que permitió llegar al diagnóstico de TB en pacientes derivados con presunción diagnóstica de cáncer al Instituto Nacional de Enfermedades Neoplásicas (INEN) entre 2014 y 2016. Se incluyeron 170 pacientes (52,4 % hombres) con edad promedio de 41,1 años, 18 % presentaron antecedentes de contacto con TB y un 5,9 % tuvo previamente la enfermedad. La TB fue pulmonar en 22,4 % y extrapulmonar en 77,7 % de los pacientes. Los síntomas más frecuentes fueron respiratorios, tumoración, pérdida de peso y neurológicos. Los diagnósticos oncológicos descartados con mayor frecuencia fueron linfoma, cáncer pulmonar y cerebral. Las lesiones que sugerían una neoplasia indicaron un estadio clínico avanzado en el 63,5 %. Se concluye que los síntomas e imágenes asociados a TB pueden confundirse con neoplasias malignas.

ABSTRACT Tuberculosis (TB) is a major public health problem that, due to the clinical variability of its presentation, can be confused with cancer. The aim of this study was to identify the clinical-radiological characteristics and to describe the methodology that allowed to achieve a TB diagnosis in patients referred to the National Institute of Neoplastic Diseases (INEN) with a presumed diagnosis of cancer between 2014 and 2016. The study included 170 patients (52.4% men) with an average age of 41.1 years; 18% presented a history of contact with TB, and 5.9% had had the disease previously. The TB was pulmonary in 22.4% and extrapulmonary in 77.7% of patients. The most frequent symptoms were respiratory, tumor, weight loss, and neurological. The cancer diagnoses most frequently discarded were lymphoma, lung cancer, and brain cancer. The lesions that suggested a neoplasm indicated an advanced clinical stage in 63.5%. Therefore, it follows that the symptoms and images associated with TB can be confused with malignant neoplasms.

Características cl¡nicas y toxicidad del tratamiento de tuberculosis en pacientes con cáncer / Clinical features and toxicity of tuberculosis treatment in patients with cancer

Objetivos. Evaluar las características clínico-epidemiológicas de la tuberculosis activa en pacientes portadores de neoplasia maligna y evaluar la influencia del tratamiento antituberculoso sobre el manejo de cáncer en el Instituto Nacional de Enfermedades Neoplásicas entre el 2008 y 2013. Materiales y métodos. Estudio observacional de casos de tuberculosis diagnosticados mediante baciloscopía positiva en pacientes con cáncer. Se revisó la información clínica, evolución, e información patológica de la neoplasia. Resultados. Se encontraron 76 casos de tuberculosis activa luego del diagnóstico de cáncer. La mediana de edad fue 51,3 años. La mediana de seguimiento fue 2,1 años. Las neoplasias más frecuentes fueron leucemia linfática aguda (14,5%) para las hematológicas y cáncer de cérvix (14,5%), mama (10,5%) y gástrico (7,9%) para las no hematológicas. El 27,6% de los pacientes presentó recurrencia de la neoplasia; el diagnóstico de tuberculosis confundió el estadiaje inicial en 6,9% y se planteó inicialmente como recurrencia del cáncer en 11,1% (neoplasias de mama y colon). El diagnóstico de tuberculosis retrasó o influyó en la reducción de dosis del tratamiento antineoplásico en 11,1% de los casos (leucemia linfática aguda y linfoma no Hodgkin). El 8,3% de los pacientes presentó toxicidad al tratamiento antituberculoso. Conclusiones. Los pacientes con cáncer pueden presentar infección activa por tuberculosis. El efecto de interferencia del diagnóstico y tratamiento de tuberculosis sobre la evaluación del cáncer y el tratamiento antineoplásico en nuestra serie es mínimo.

Objectives. To assess the clinical and epidemiological characteristics of active tuberculosis in patients with malignancy and to assess the influence of TB treatment on cancer management at the National Institute of Neoplastic Diseases from 2008 to 2013. Materials and methods. Observational study of TB cases diagnosed by positive sputum microscopy in patients with cancer. Clinical information, evolution, and pathologic information of neoplasia was reviewed. Results.76 cases of active tuberculosis after being diagnosed with cancer were found. The median age was 51.3 years. Median follow-up was 2.1 years. The most common cancers were acute lymphocytic leukemia (14.5%), for the hematologic cancers; and cancer of the cervix (14.5%), breast (10.5%), and gastric (7.9%) for non-hematological cancers. 27.6% of patients had recurrence of the tumor; TB diagnosis confounded the initial staging by 6.9% and was initially stated as cancer recurrence in 11.1% (breast and colon cancers). The diagnosis of tuberculosis delayed or influenced the dose reduction of the antineoplastic treatment in 11.1% of the cases (acute lymphocytic leukemia and non-Hodgkin lymphoma). 8.3% of patients had toxicity to the TB treatment. Conclusions. Cancer patients may have active tuberculosis infection. The interference effect of diagnosis and treatment of tuberculosis on the assessment of cancer and cancer treatment in our series is minimal.

Staphylococcus aureus resistente a meticilina adquirido en la comunidad aislados en tres hospitales de Lima-Perú / Methicillin resistant Staphylococcus aureus isolates acquired in the community in three hospitals in Lima, Peru

Staphylococcus aureus es un importante patógeno involucrado en una serie de infecciones e intoxicaciones, presenta múltiples factores de virulencia y su impacto se incrementa por su notable resistencia a los antimicrobianos. Objetivo: Determinar la frecuencia de Staphylococcus aureus meticilino resistente adquiridos en la comunidad, en hospitales de Lima- Perú. Material y métodos: Se realizó un estudio descriptivo multicéntrico. La resistencia a meticilina se determinó por el método Oxacillin Agar Screen. El origen de la cepa fue determinado mediante los criterios de los CDC; la Leucocidina de Panton Valentine fue identificada por métodos moleculares. Resultados: Se aislaron 276 cepas de Staphylococcus aureus, 160 fueron resistentes a meticilina (58 por ciento), 9 de ellas fueron identificadas como adquiridas en la comunidad (5,6 por ciento). La PVL fue identificada en 25 cepas (9,1 por ciento), 14 fueron MSSA y 11 MRSA, de éstas últimas solo 4 fueron MRSAcom, 7 fueron MRSAhosp (p menor que 0,001). Conclusiones: El estudio revela niveles elevados de resistencia a meticilina, pero niveles bajos de MRSAcom. En nuestro medio la presencia de PVL no constituiría un marcador para la identificación de los MRSAcom.

Background: Staphylococcus aureus is an important pathogen involved in a series of infections and toxin mediated syndromes, has many virulence factors and its impact increases its resistance to antimicrobial agents. Objectives: To determine the frequency of community acquired methicillin resistant Staphylococcus aureus among hospitals in Lima -Peru. Material and Methods: We performed a prospective multicenter study. The resistance to methicillin was determined by the Oxacillin Agar Screen method. The origin of the strain was determined using CDC criteria, the Panton Valentine Leucocidin was identified by molecular methods. Results: We isolated 276 strains of Staphylococcus aureus, 160 were resistant to methicillin (58 per cent). 9 strains were identified as community acquired MRSA (5.6 per cent). The Panton Valentine Leucocidin was identified in 25 strains (9.1 per cent), 14 were MSSA and 11 MRSA, only 4 of the latter were CA MRSA, 7 were HA MRSA (p less than 0.001). Conclusions: The study showed frequencys of methicillin resistance, but low CA MRSA. In our environment the presence of PVL would not be a marker for the identification of CA MRSA.