Fiebre tifoidea: una etiología poco frecuente de síndrome febril prolongado en pediatría / Typhoid fever: a rare etiology of prolonged febrile illness in pediatrics / Febre tifoide: uma etiología rara de síndrome febril prolongada em pediatría

Introducción: Las infecciones representan la etiología más frecuente del síndrome febril prolongado (SFP). Si bien las fiebres entéricas constituyen una causa posible, en Uruguay su prevalencia ha disminuido significativamente con la mejora de las condiciones socio sanitarias. Objetivo: Comunicar el caso de un adolescente con una etiología actualmente excepcional de SFP. Caso clínico 14 años, sano, zona suburbana. Comienza 2 semanas previo al ingreso con dolor en hemiabdomen superior. Agrega cefalea holocraneana leve y vómitos ocasionales. 5 días previos al ingreso fiebre 40°C axilar, un pico diario, sin otra sintomatología. Tránsito digestivo bajo y urinario normal. Examen físico: lúcido, buen aspecto general, abdomen doloroso a la palpación profunda en epigastrio. Sin irritación peritoneal. Resto normal. Analítica: Leucocitos 5200mm3, Proteína C reactiva 71.4mg/dL, hemocultivo sin desarrollo. Ecografía abdominal, radiografía de tórax y ecocardiograma normales. Serologías para Virus Epstein Barr, Citomegalovirus, y Bartonella henselae negativas. Orina normal, urocultivo sin desarrollo. Persiste con fiebre, agrega exantema macropapular evanescente en tronco, sin otros síntomas. Al 7° día de internación nuevo hemocultivo: Salmonella Typhi sensible a ampicilina que recibe por 14 días. Buena evolución. Discusión: La fiebre tifoidea es una enfermedad infectocontagiosa, aguda, potencialmente mortal. Las condiciones socioeconómicas son determinantes en su transmisión. La sensibilidad del hemocultivo es mayor durante la primera semana de enfermedad, por lo que en ocasiones es necesario reiterarlo. Sus manifestaciones clínicas inespecíficas y la baja incidencia hacen que esta etiología no sea habitualmente sospechada en nuestro medio. Por tanto, es importante aumentar el índice de sospecha y considerar entre los diagnósticos diferenciales de SFP esta etiología.

Introduction: Infections are the most frequent etiology of prolonged febrile illness (PFI). Although enteric fevers are a possible cause, their prevalence has significantly diminished in Uruguay, due to improved socio-sanitary conditions. Objective: To communicate the case of an adolescent with a currently exceptional etiology of PFI. Clinical case: 14 years old, healthy, suburban area. Two days prior to admission the patient has pain in upper hemi abdomen. Adds mild holocranial headache and occasional vomiting. 5 days prior to admission axilary temperature of 40°C, one daily peak, without other symptoms. Normal lower digestive and urinary transit. Physical examination: lucid, good general aspect, pain at deep palpation in epigastrium. No peritoneal irritation. Rest is normal. Laboratory: leukocytes 5200 mm3, C-reactive protein 71.4mg/dL, blood culture shows no growth. Abdominal sonogram, thoracic X-ray and echocardiogram are normal. Negative serology for Epstein Barr Virus, Cytomegalovirus and Bartonella henselae. Normal urine, urine culture with no growth. Fever persists, adds evanescent macropapular exanthema in on the trunk, without other symptoms. On the 7th day in hospital a new blood culture shows Salmonella Typhi sensitive to ampicillin, which he receives for 14 days. Good evolution. Discussion: Typhoid fever is an acute, life-threatening, infectious disease. Socioeconomic conditions are determinant in its transmission. Blood culture sensitivity is greater during the first week of the disease, that is why it must occasionally be repeated. Its unspecific clinical manifestations and low incidence make this etiology not be usually suspected in our surroundings. It is therefore important to increase our suspicion and to consider it amongst differential diagnosis in PFI.

Introdução: As infecções representam a etiologia mais frequente da síndrome febril prolongada (SFP). Embora as febres entéricas sejam uma causa possível, no Uruguai sua prevalência diminuiu significativamente com a melhoria das condições sociossanitárias. Objetivo: Relatar o caso de um adolescente com etiologia atualmente excepcional de SFP. Caso clínico 14 anos, saudável, zona suburbana. Começa 2 semanas antes da admissão com dor no abdome superior. Adiciona dor de cabeça holocraniana leve e vômitos ocasionais. 5 dias antes da admissão febre 40°C axilar, pico diário, sem outros sintomas. Trânsito digestivo inferior e trânsito urinário normais. Exame físico: lúcido, bom aspecto geral, abdome doloroso à palpação profunda no epigástrio. Sem irritação peritoneal. Resto normal. Análise: Leucócitos 5200mm3, proteína C reativa 71,4mg/dL, hemocultura sem desenvolvimento. Ultrassonografia abdominal, radiografia de tórax e ecocardiograma foram normais. As sorologias para vírus Epstein Barr, Citomegalovírus e Bartonella henselae foram negativas. Urina normal, urocultura sem desenvolvimento. Persiste com febre, acrescenta erupção macropapular evanescente no tronco, sem outros sintomas. No 7º dia de internação, nova hemocultura: Salmonella Typhi sensível à ampicilina, que recebeu por 14 dias. Boa evolução. Discussão: A febre tifóide é uma doença infecciosa aguda, potencialmente fatal. As condições socioeconômicas são decisivas na sua transmissão. A sensibilidade da hemocultura é maior durante a primeira semana da doença, por isso às vezes é necessário repeti-la. Suas manifestações clínicas inespecíficas e baixa incidência fazem com que essa etiologia não seja usualmente suspeitada em nosso meio. Portanto, é importante aumentar o índice de suspeição e considerar essa etiologia entre os diagnósticos diferenciais da SFP.

Inadvertent epidural ampicillin administration during labor: case report / Administração peridural inadvertida de ampicilina durante trabalho de parto: relato de caso

Abstract Background: Inadvertent epidural drug administration is associated with morbidity and mortality. Several drugs have been administered accidentally through the epidural catheter and most of our knowledge is based on case reports. Case report: A 33 year-old woman presented for delivery. Placement of epidural catheter was requested for labor analgesia and priming dose was administered. Five minutes later, ampicillin 1 g was given through the catheter inadvertently without hemodynamic or neurological changes. Ropivacaine administration was repeated, always with symptomatic relief until delivery. At hospital discharge, she remained without neurological or hemodynamic alterations. Conclusions: The majority of errors are due to syringe and drug exchanges and inadvertent route administration. Erroneous administration into the epidural space can have immediate and late effects and there is no definitive and effective treatment. There are several preventive measures to reduce the potential complications; some opt for watchful waiting, others opt for administering other drugs as a dilution attempted.

Resumo Justificativa: A administração inadvertida peridural de drogas está associada à morbidade e mortalidade. Várias drogas foram administradas acidentalmente pelo cateter peridural e a maior parte do que sabemos se baseia em relatos de caso. Relato de caso: Uma gestante de 33 anos chegou em trabalho de parto. Foi solicitada colocação de cateter peridural para analgesia de parto e a dose inicial foi administrada. Cinco minutos depois, 1 g de ampicilina foi dado através do cateter inadvertidamente, sem alterações hemodinâmicas ou neurológicas. A administração de ropivacaína foi repetida, sempre com alívio dos sintomas até o parto. Na alta hospitalar, a paciente continuava sem alterações neurológicas ou hemodinâmicas. Conclusões: A maioria dos erros é por troca de seringa ou drogas, ou administração de rota inadvertida. A administração errônea no espaço peridural pode apresentar efeitos imediatos e tardios e não há tratamento definitivo ou efetivo. Existem várias medidas preventivas para reduzir complicações potenciais; alguns escolhem observação cuidadosa, outros a administração de outras drogas para tentar a diluição.

ANTIBIOTIC PROPHYLAXIS IN BARIATRIC SURGERY: a continuous infusion of cefazolin versus ampicillin/sulbactam and ertapenem / Antibioticoprofilaxia em cirurgia bariátrica: infusão contínua de cefazolina versus ampicilina/sulbactam e ertapenem

Background The incidence of surgical site infection in bariatric patients is significant and the current recommendations for antibiotic prophylaxis are sometimes inadequate. Objective The aim of this study was to analyze the effect of three prophylactic antibiotic regimens on the incidence of surgical site infection. Methods A prospective, cross-sectional study was conducted between January 2009 and January 2013 in which 896 Roux-en-Y gastric bypasses were performed to treat obesity. The study compared three groups of patients according to the perioperative antibiotic prophylaxis administered intravenously and beginning at anesthesia induction: Group I consisting of 194 patients treated with two 3-g doses of ampicillin/sulbactam; Group II with 303 patients treated with a single 1-g dose of ertapenem; and Group III with 399 patients treated with a 2-g dose of cefazolin at anesthesia induction followed by a continuous infusion of cefazolin 1g throughout the surgical procedure. The rate of surgical site infection was analyzed, as well as its association with age, sex, preoperative weight, body mass index and comorbidities. Results The rates of surgical site infection were 4.16% in the group treated prophylactically with ampicillin/sulbactam, 1.98% in the ertapenem group and 1.55% in the continuous cefazolin group. Conclusion The prophylactic use of continuous cefazolin in surgeries for morbid obesity shows very promising results. These findings suggest that some prophylactic regimens need to be reconsidered and even substituted by more effective therapies for the prevention of surgical site infections in bariatric patients. .

Contexto A incidência de infecção de sítio cirúrgico em pacientes bariátricos é significativa e as recomendações atuais para a profilaxia antibiótica são por vezes inadequadas. Objetivo O objetivo deste estudo foi analisar o efeito de três esquemas de antibióticos profiláticos sobre a incidência de infecção de sítio cirúrgico. Método Estudo prospectivo, transversal, foi realizado entre janeiro de 2009 e janeiro de 2013, em que 896 derivações gástricas em Y de Roux foram realizadas para tratar a obesidade. O estudo comparou três grupos de pacientes de acordo com a profilaxia antibiótica administrada no perioperatória por via intravenosa, iniciada na indução anestésica: Grupo I constituído de 194 pacientes tratados com duas doses de 3 g de ampicilina/sulbactam; Grupo II com 303 pacientes tratados com uma única dose de 1 g de ertapenem; e Grupo III com 399 pacientes tratados com uma dose de 2 g de cefazolina no momento da indução da anestésica seguida de uma infusão contínua de cefazolina 1 g durante o procedimento cirúrgico. A taxa de infecção de sítio cirúrgico foi analisada, bem como a sua associação com a idade, sexo, peso pré-operatório, o índice de massa corporal e comorbidades. Resultados As taxas de infecção do sítio cirúrgico foram de 4,16% no grupo tratado profilaticamente com ampicilina/sulbactam, 1,98% no grupo de ertapenem e 1,55% no grupo de cefazolina contínua. Conclusão O uso profilático de cefazolina contínua em cirurgias para obesidade mórbida apresenta resultados muito promissores. Estes resultados sugerem que alguns regimes profiláticos precisam ser reconsiderados e até mesmo substituídos por terapias mais eficazes para a prevenção de infecções de sítio cirúrgico em pacientes bariátricos. .

The efficacy of immediate versus delayed antibiotic administration on bacterial growth and biofilm production of selected strains of uropathogenic Escherichia coli and Pseudomonas aeruginosa

Purpose The treatment of urinary tract infections (UTI) with antibiotics is commonly used, but recurrence and antibiotic resistance have been growing and concerning clinicians. We studied whether the rapid onset of a protective biofilm may be responsible for the lack of effectiveness of antibiotics against selected bacteria. Materials and Methods Two established uropathogenic Escherichia coli strains, UTI89 and CFT073, and two Pseudomonas aeruginosa strains, PA01 and Boston-41501, were studied to establish a reliable biofilm formation process. Bacterial growth (BG) was determined by optical density at 600 nm (OD 600) using a spectrophotometer, while biofilm formation (BF) using crystal violet staining was measured at OD 550. Next, these bacterial strains were treated with clinically relevant antibiotics, ciprofloxacin HCl (200 ng/mL and 2 μg/mL), nitrofurantoin (20 μg/mL and 40 μg/mL) and ampicillin (50 μg/mL) at time points of 0 (T0) or after 6 hours of culture (T6). All measurements, including controls (bacteria -1% DMSO), were done in triplicates and repeated three times for consistency. Results The tested antibiotics effectively inhibited both BG and BF when administered at T0 for UPEC strains, but not when the antibiotic administration started 6 hours later. For Pseudomonas strains, only Ciprofloxacin was able to significantly inhibit bacterial growth at T0 but only at the higher concentration of 2 μg/mL for T6. Conclusion When established UPEC and Pseudomonas bacteria were allowed to culture for 6 hours before initialization of treatment, the therapeutic effect of selected antibiotics was greatly suppressed when compared to immediate treatment, probably as a result of the protective nature of the biofilm. .

The minimal inhibitory concentration for sulbactam was not associated with the outcome of infections caused by carbapenem-resistant Acinetobacter sp. treated with ampicillin/sulbactam

OBJECTIVE: The objective of this study was to evaluate whether the outcomes of carbapenem-resistant Acinetobacter infections treated with ampicillin/sulbactam were associated with the in vitro susceptibility profiles. METHODS: Twenty-two infections were treated with ampicillin/sulbactam. The median treatment duration was 14 days (range: 3-19 days), and the median daily dose was 9 g (range: 1.5-12 g). The median time between Acinetobacter isolation and treatment was 4 days (range: 0-11 days). RESULTS: The sulbactam minimal inhibitory concentration (MIC) ranged from 2.0 to 32.0 mg/L, and the MIC was not associated with patient outcome, as 4 of 5 (80%) patients with a resistant infection (MIC≥16), 5 of 10 (50%) patients with intermediate isolates (MIC of 8) and only 1 of 7 (14%) patients with susceptible isolates (MIC ≤4) survived hospitalization. CONCLUSION: These findings highlight the need to improve the correlation between in vitro susceptibility tests and clinical outcome. .

O uso da talidomida como terapia adjuvante na leptospirose experimental / The use of thalidomide as adjuvant therapy in experimental leptospirosis

A leptospirose é uma zoonose de importância global, causada por leptospiras patogênicas. Seu tratamento é limitado quando iniciado após quatro dias do surgimento de sintomas, portanto, novas terapias adjuvantes são necessárias. Objetivo. Testar a droga imunomoduladora talidomida como terapia adjuvante à ampicilina no modelo de tratamento tardio da leptospirose experimental em hamsters. Métodos. 60 hamsters foram infectados via intraperitoneal por Leptospirainterrogans cepa L1-130, e foram separados em grupos: nenhum tratamento (NONE), talidomida (TAL), ampicilina (AMP) e ambos (AMP-TAL)...

Leptospirosis is a zoonosis of global importance, caused by pathogenic leptospira. His treatment is limited when started after four days of onset of symptoms, increasing the risk of morbidity and mortality, so new adjuvant therapies are needed.Objectives.To test the immunomodulatory drug, thalidomide, as an adjuvant therapy to antibiotics in experimental leptospirosis. Methods. Hamsters were infected by Leptospirainterrogans strain L1-130, and groups were assigned based on no treatment (NONE), thalidomide only (TAL), ampicillin only (AMP) or both (AMP-TAL). Thalidomide was administered via a gastric tube: 50 mg/kg in linseed oil and 2 ml/kg for three days. Ampicillin was administered intramuscularly at the rate of 100 mg/kg/bid for six days. Treatment was started two days after the onset of symptoms (experiment 1) and immediately after detection of the first death (experiment 2). Results. Experiment 1: all hamsters from the groups AMP and AMP-TAL...

Effect of Lactobacillus acidophilus & epidermal growth factor on experimentally induced Clostridium difficile infection.

Background & objectives: Clostridium difficile-associated disease (CDAD) remains an important nosocomial ailment. Antimicrobial therapy used for CDAD gives inconsistent results. This experimental study was planned to investigate the beneficial effects of Lactobacillus acidophilus and epidermal growth factor (EGF) for CDAD management. Methods: Among 10 groups of BALB/c mice (6 in each), group 1 served as controls receiving no inoculum. Animals in groups 2-10 received C. difficile, those in groups 3, 6 and 9 received L. acidophilus and those in groups 4, 7 and 10 received EGF after C. difficile inoculation. Animals in groups 5-7 were pre-treated with ampicillin and those in groups 8-10 with lansoprazole prior to C. difficile. The animals were killed and investigated for colonisation by C. difficile and toxin production, myeloperoxidase (MPO) activity and histopathology. Results: Colonisation by C. difficile was found to be significantly different (P<0.001) in the various groups. C. difficile toxin titres and MPO activity were significantly lower in animals given L. acidophilus and EGF after ampicillin (groups 6 and 7) and lansoprazole (groups 9 and 10). The severity of acute inflammation was also significantly less (P<0.05) in caecal and colonic segments of animals in groups 6 and 7 compared to those in group 5. Although the severity of acute inflammation was less in the caecal and colonic segment of animals in groups 9 and 10, the reduction was not significant compared to group 8. Interpretation & conclusions: Our findings showed that the administration of L. acidophilus and EGF reduced the severity of C. difficile infection in the experimental animals.

Histomorphometric changes in the testes and epididymis of wistar strain albino rats following fourteen days oral administration of therapeutic doses of some antibiotics / Cambios histomorfométricos en los testículos y el epidídimo de ratas cepa wistar albinas después de catorce días de administración oral de dosis terapéuticas de algunos antiobióticos

Studies on testes and epididymis tissue of rats treated orally for fourteen days with therapeutic doses of cloxacillin (6mg/100g/day), ampicillin (4mg/100/day) and tetracycline (12mg/100g/day) separately showed a significant reduction in testicular and epididimis architecture. Microscopic studies of these male reproductive organs further revealed a significant alteration in the epididymis as revealed by a significant reduction (p<0.05) in epididymal ductular diameter (EDD), and epididymal epithelial height (EEH) in treated group of animals. A significant increase (p<0.05) was however recorded in epididymal luminal diameter (ELD) in all the animals after the two and three week's recovery period allowed. This gives another insight into the toxicity activities of these antibiotics on male reproductive organs, apart from reduction in serum testosterone level, decreased sperm motility, decreased spermatozoa count and decrease in RNA and DNA content of spermatogenic cells as earlier reported.

Estudios referentes a testículos y tejido epididimario en ratas tratadas por vía oral durante catorce días, con dosis terapéuticas de cloxacilina (6mg/100g/día), ampicilina (4mg/100/día) y tetraciclina (12mg/100g/día) por separado muestran una reducción significativa en el peso testicular y epidídimario. Los estudios microscópicos de los órganos reproductores masculinos revelan además una alteración significativa en el epidídimo como se observa en la reducción del diámetro (p<0,05) de los conductos del epidídimo (EDD), y la altura del epitelio epididimal (EEH) en el grupo de los animales tratados. Sin embargo, se registró un aumento significativo (p <0,05) en el diámetro luminal del epidídimo (ELD) en todos los animales después de dos y tres semanas del período de recuperación. Esto genera otro punto de vista en relación a la toxicidad de estos antibióticos en los órganos reproductivos masculinos, además de la reducción de la concentración sérica de testosterona, disminución de la motilidad del esperma, disminución del recuento de espermatozoides y disminución en el contenido de ARN y ADN en las células de espermatogénesis como se reportó anteriormente.

Colecistectomía laparoscópica con un sólo puerto visible subxifoideo de 5 mm: experiencia en Venezuela / Laparoscopic cholecystectomy with a single subxyphoid port of 5 mm: our experience in Venezuela

Presentar nuestra experiencia en 18 colecistectomías laparoscópicas con un sólo puerto visible subxifoideo de 5 mm, obtenida en el Departamento de Cirugía de dos hospitales privados, con el fin de introducir en nuestro país las técnicas que disminuyan aún más el trauma de la laparoscopia tradicional. Estudio prospectivo, observacional. Fueron intervenidos 18 pacientes con la técnica de colecistectomía laparoscópica con un sólo puerto visible subxifoideo, en el período de enero a abril de 2008. Se excluyeron casos de colecistitis aguda, coledocolitiasis y cáncer. Se analizaron la edad, sexo, el tiempo quirúrgico, la estancia hospitalaria, las complicaciones, el índice de conversión y los efectos estéticos. Predominó el sexo femenino (17 a 1). La edad promedio fue de 41 años. El tiempo quirúrgico promedio fue de 67 minutos (58 minutos promedio con el uso del ligasure y 98 minutos sin este equipo). El tiempo de hospitalización fue de 24 horas. Se evidenció una sola cicatriz a nivel subxifoideo, en contraste con la técnica laparoscópica habitual, con 3 cicatrices visibles. No hubo conversiones. No hubo morbilidad ni mortalidad. La técnica es perfectamente reproducible en nuestro medio, aportando beneficios adicionales estéticos a la colecistectomía laparoscópica tradicional.

Detection of tdh and trh genes in Vibrio parahaemolyticus isolated from Corbicula moltkiana prime in West Sumatera, Indonesia.

The occurrence of Vibrio parahaemolyticus in raw Corbicula moltkiana Prime from Lake Singkarak and Pasar Raya Padang market and in cooked samples in West Sumatera, Indonesia, was studied. Thirteen raw and seven cooked bivalve samples were positive using CHROMAgar Vibrio medium. All 47 V parahaemolyticus isolates were positive for toxR gene but negative for trh. However, 36% (17/47) of V parahaemolyticus strains were positive for tdh gene. Antibiotic profiling showed that 76% and 38% of isolates from raw and cooked bivalves respectively were resistant to ampicillin. Using RAPD-PCR analysis, most of the strains were clustered according to their source of isolation but some of the strains from raw and cooked samples were clustered together. These results indicate that pathogenic V parahaemolyticus isolates are present in Corbicula moltkiana Prime in West Sumatera, Indonesia, suggesting that V parahaemolyticus may also be present in seafood in other regions of Indonesia.

Synergy of Arbekacin-based Combinations Against Vancomycin Hetero-intermediate Staphylococcus aureus

This study was undertaken to evaluate the in vitro activities of arbekacin-based combination regimens against vancomycin hetero-intermediate Staphylococcus aureus (hetero-VISA). Combinations of arbekacin with vancomycin, rifampin, ampicillin-sulbactam, teicoplanin, or quinipristin-dalfopristin against seven hetero-VISA strains and two methicillin-resistant S. aureus strains were evaluated by the time-kill assay. The combinations of arbekacin with vancomycin, teicoplanin, or ampicillinsulbactam showed the synergistic interaction against hetero-VISA strains. Data suggest that these arbekacin-based combination regimens may be useful candidates for treatment options of hetero-VISA infections.

Evaluación de la autoinmunidad en ratones BALB/c inmunizados con una biblioteca genómica de expresión de Trypanosoma cruzi / Evaluation of autoimmunuty in Balb/c mice immunized with a genomic library of expression of Trypanosoma cruzi

Uno de los problemas de la seguridad para las vacunas de ADN es la inducción de fenómenos de autoinmunidad. Nosotros examinamos el efecto de la inmunización con ácidos nucleicos de Trypanosoma cruzi en la inducción de diferentes autoanticuerpos en ratones de Balb/c. Los animales fueron divididos en cinco grupos: los primeros cuatro recibieron diferentes esquemas: 25 µg de la biblioteca genómica de expresión (grupo L), 25 µg de antígenos solubles de T. cruzi (grupo T), 25 µg del plásmido pcDNA3 (grupo P), 25 µg de genómica ADN de T. cruzi (grupo G) y un grupo control de animales no inmunizados. Los anticuerpos antinucleares y anticuerpos contra músculo cardíaco fueron evaluados por immunofluorescencia indirecta y los anticuerpos anti ADN de doble, simple cadena y el anti IgG factor reumatoideo fueron determinados semanalmente por ELISA. La vacunación no provocó la inducción de anticuerpos anti ADN de doble o simple cadena, anticuerpos antinucleares ni contra músculo cardíaco. Se observó un aumento transitorio del Factor Reumatoideo IgG en los ratones inmunizados con la biblioteca genómica de expresión de T. cruzi. Nuestros hallazgos sugieren que la inducción de respuestas autoinmunes frente al ADN utilizado en la inmunización es poco probable

Dosis única adicional como tratamiento en el posparto para mujeres con corioamnionitis / Single additional dose postpartum therapy for women with chorioamnionitis

Objetivo: Este estudio se realizó para determinar si una sola dosis adicional de antibióticos de amplio espectro constituye un tratamiento adecuado para mujeres con corioamnionitis. Métodos: Pacientes con diagnóstico de coriamnionitis clínica recibieron tratamiento con ampicilina 2 g cada 6 horas y gentamicina 1,5 mg/kg cada 8 horas. Después del parto las pacientes fueron randomizadas para continuar con este esquema hasta que se mantuvieran afebriles y asintomáticas por 24 horas (grupo control) o recibir una sola dosis de cada fármaco en el próximo horario programado (grupo estudio). Si el parto fue por cesárea, las pacientes recibieron clindamicina 900 mg intravenoso después de cortar el cordón umbilical. El grupo control continuó recibiendo clindamicina cada 8 horas hasta que los antibióticos fueron discontinuados. El resultado primario fue la falla en el tratamiento, definida como una sola toma de temperatura de 39,0ºC o más después de la primera dosis de antibióticos en el post parto o dos cifras de 38,4ºC con al menos 4 horas de intervalo. Se estimó que 292 pacientes fueron necesarias para detectar un incremento de 150 por ciento en la tasa de falla del tratamiento, de 8 por ciento en el grupo control a 20 por ciento en el grupo estudio (alfa= 0,05; 1-beta= 0,80). Resultados: Desde el 26 de diciembre de 1999 al 18 de marzo de 2003, un total de 292 mujeres fueron enroladas en el estudio. En el análisis según intención de tratar, la falla de tratamiento no tuvo diferencia entre el grupo control (n=141) y el grupo estudio (n=151) (3,5 por ciento versus 4,6 por ciento, p=0,639). Conclusión: Si se trató precozmente en el intraparto, una sola dosis adicional de antibióticos de amplio espectro es suficiente como terapia en el post parto para mujeres inmunocompetentes con corioamnionitis.

Neonatal Salmonella typhimurium meningitis.

Meningitis due to Salmonella is a very rare sign of Salmonellosis. A 10-day-old female premature neonate with Salmonella typhimurium meningitis is presented in this report. The clinical features, outcome and antibiotic treatment are discussed. Although it is extremely rare, Salmonella meningitis should be considered in differential diagnosis of neonatal meningitis.

Manejo de las mordeduras de serpientes venenosas en pacientes atendidos en el servicio, de medicina interna en el Hospital Escuela Oscar Danilo Rosales, durante el período de enero 1997-noviembre 1999

En el presente estudio se encontro que el grupo de edad más afectado con mordeduras de serpientes correspondió de 12 a 20 años lo cual coincide con estudios internacionales, donde se reporta que las edades mas afectadas por accidente ofídico es la comprendida entre 10 y 19 años lo cual esta en correspondencia a la actividad laboral ya que la gran mayoría se dedica a la agricultura y pertenece al área rural y es campesino. Con respecto a los tipos de serpientes, la más frecuente que ocasionó accidentes ofídico fue serpiente cascabel con un 41.7 porciento, seguido de serpientes desconocidas en un 38.9 porcientos, sólo se presentó un caso de mordedura de coral. Podemos observar que en relación al tiempo transcurrido entre la mordedura de serpiente y la atención hospitalaria fue en promedio de 8 horas con una desviación estándar de 9.1 horas. Se presentaron los resultados clínicos de la familia de serpientes viperidae, en donde se observa que los datos de laboratorio hubo una prolongación en tiempo de protombina siendo en promedio de 15.4 +- 10.3 segundos. Un 44 porciento de los accidentes correspondió a persona que deambulaban y un 43.1 porciento durante el trabajo en el campo. El área anatómica más frecuente afectada correspondió a miembro inferior izquierdo en un 38.9 porciento. Del total de pacientes 89 porciento recibieron suero antiofídico polivante, 96 porciento tratamiento con penicilina cristalina, en un 14 porciento gentamicina y se utilizó un tercer antibiótico en un 8.3 porciento de los pacientes. Recibieron terapia analgésica con diclofenac sódico en un 8.3 porciento. Se indicó el uso de hidrocortisona en 18.1 porciento de los pacientes y en un 7 porciento de dichos pacientes no se aplicó toxoide cuando estaba indicada. El 62.5 porciento de los pacientes recibió hidroterapia y se aplicó inmunoglobulina antitetánica humana en un 82 porciento. Hubo complicaciones hemorrágicas y se reportó un caso de amputación

Sensibilidad antimicrobiana in vitro de Streptococcus pyogenes aisaldo en infecciones respiratorias / Streptococcus pyogenes isolated from respiratory infections in vitro antimicrobial sensibility

Las infecciones agudas del tracto respiratorio constituyen un importante problema de salud, ya que representan la principal causa de morbilidad y mortalidad, sobre todo en edades pediátricas. Las bacterias causales han mostrado una marcada tendencia en los últimos años de resistencia a los antimicrobianos. Una notable excepción a este fenómeno ha sido Streptococcus pyogenes.Se estudió la susceptibilidad antimicrobiana de 312 cepas de S. pyogenes aisladas de infecciones del tracto respiratorio en el lapso de cinco años en el Laboratorio Clínico del Hospital de Infectología del Centro Médico Nacional "La Raza", a 12 diferentes antimicrobianos, utilizando la técnica de dilución en placa.Ninguna de las 312 cepas mostró resistencia a los antimicrobianos estudiados; las concentraciones inhibitorias mínimas variaron de acuerdo con éstos.De los antimicrobianos estudiados se consideró a la ampicilina como el antimicrobiano de elección para el tratamiento de las infecciones respiratorias causadas por S. pyogenes, por su espectro de actividad antimicrobiana, vía de administración, bajo costo y baja frecuencia de efectos colaterales