[Viral etiology of community acquired pneumonia among adults admitted to a general hospital]. / Etiología viral en la neumonía del adulto adquirida en la comunidad en un hospital del sur de Chile.

BACKGROUND: There is paucity of information about viral etiology of community acquired pneumonia in adults. AIM: To investigate the viral etiology of pneumonia among hospitalized patients. MATERIAL AND METHODS: All adults with pneumonia that were hospitalized were prospectively enrolled at Puerto Montt hospital. A microbiological and viral assessment was carried out. Viral assessment included direct immunofluorescence of nasopharyngeal aspirates for influenza A and B virus and serum samples obtained during the acute phase of the disease and during convalescence for Hanta virus. RESULTS: Between April 1 2005 and March 31 2006,159 adults aged 62 ± 20 years (58 % males), were admitted to the hospital for pneumonia. Mean hospital stay was 11.9 ± 8.6 days. Four patients had Hantavirus acute infection. Other viruses were identified in twelve patients (7.7%). Nine had influenza A, one syncytial respiratory virus, one syncytial and influenza A virus and one varicella zoster virus. Excluding patients with Hantavirus, no significant differences in age, clinical presentation, chest X ray findings, laboratory results and mortality were observed between patients with bacterial or viral etiology of the pneumonia. CONCLUSIONS: Viral etiology was confirmed in 10% of adult patients hospitalized with community acquired pneumonia.

[Importance of images and etiological diagnosis in immunocompromised patients with central nervous system involvement. Third part]. / Importancia de las imágenes y el diagnóstico etiológico en el paciente inmunocomprometido con afección del sistema nervioso central: Tercera parte.

A twenty four year-old male patient with a history of morbid obesity and acute lymphocytic leukemia diagnosed in 2003, underwent an autologous bone marrow transplantation the same year. He had two relapses of leukemia on 2003 and 2007. On January 2009, he underwent a double cord bone marrow transplantation with myeloablative conditioning and craneospinal radiotherapy. The patient received prophylaxis with aciclovir, cotrimoxazole and fluconazole. The latter was changed afterwards to posaconazole. On day 16 post-transplantation, fever and meningeal signs appeared. The cerebrospinal fluid exam revealed pleocytosis with polymorphonuclear predominance. Empirical therapy was started with meropenem. Due to neurological impairment, at day 33, a brain magnetic resonance imaging (MRI) was performed, showing multiple hypodense supra and infratentorial nodules with peripheral edema. Biopsy, universal PCR for fungi and a new cerebrospinal fluid analysis were performed and amphotericin B was added showing a favorable response. He was discharged with itraconazole, as the universal PCR of brain tissue revealed Penicillium spp. This is the third report presented in this journal that stresses the importance of early neuroimaging, especially MRI to certify the involvement of the central nervous system in immunocompromised patients.

[Pandemic influenza A (H1N1) 2009: epidemiology, clinical features and differences with seasonal influenza in Chile]. / Influenza pandémica A (H1N1) 2009: epidemiología, características clínicas y diferencias con influenza estacional en Chile.

UNLABELLED: Pandemic influenza A (H1N1) 2009 raised questions regarding differences with seasonal influenza. OBJECTIVES: To describe the clinical features of pandemic influenza and compare them to seasonal influenza. PATIENTS Y METHODS: A descriptive study that compared hospitalized adults was done between patients with confirmed pandemic influenza in the Hospital Clínico Universidad Católica in Santiago, Chile, from May to July 2009 and 95 confirmed historic cases of seasonal influenza. RESULTS: 54 patients with pandemic influenza were included, 51.9% were male, age of 52.8 ± 19.5 years old; 79.6% had chronic diseases; 16.7% were immunocompromised patients and 7.4% of pregnant women. 25.9% of the patients acquired the infection during the hospitalization. 31.5% were admitted to intermediate/intensive care units. Pneumonia was diagnosed in 37%, and the mortality rate was 3.7%. The comparison between pandemic and seasonal influenza showed less proportion of patient > 65 years of age (31.5% vs. 68%; p < 0.0001); double number of nosocomial acquisition and more cases of pneumonia and death. CONCLUSIONS: The pandemic influenza infection affected younger people and was related with more nosocomial cases, pneumonia and mortality rates than seasonal influenza.

[Human bocavirus in Chile: clinical characteristics and epidemiological profile in children with acute respiratory tract infections]. / Bocavirus humano en Chile: características clínicas y epidemiológicas en niños con infecciones respiratorias.

BACKGROUND: Human bocavirus (HBoV) is a newly discovered parvovirus found in children with acute respiratory tract infections (ARTI). OBJECTIVES: To describe the epidemiological and clinical profile of children < 5 years old consulting for ARTI, comparing cases of HBoV monoinfection and coinfection with other known respiratory viruses. Furthermore, we aimed to estimate the prevalence of viral shedding in asymptomatic children and perform phylogenetic analysis. PATIENTS AND METHODS: We investigated the presence of HBoV in nasopharyngeal secretions from children consulting for AlRTI and among asymptomatic controls, between 2007 and 2008, by polymerase chain reaction. RESULTS: HBoV was detected in 79 (21.8%) of 362 nasopharyngeal swabs obtained from children with ARTI. In 60/79 (76%), coinfection with other respiratory viruses was confirmed. Most common symptoms were cough, fever and rhinorrhea. Children infected only with HBoV showed significantly lower frequencies of respiratory distress, oxygen requirements and hospital admission than those with coinfection. HBoV was detected in 6/16 (37.5%) samples from asymptomatic children. The phylogenetic analysis of viruses from Chilean patients revealed that circulating HBoV was closely related to original strains. CONCLUSIONS: HBoV was found either in symptomatic and asymptomatic children. The severity of the disease was greater when HBoV was associated to other respiratory viruses.

[Importance of images and etiological diagnosis of central nervous system involvement in immunocompromised patient]. / Importancia de las imágenes y el diagnóstico etiológico en el paciente inmunocomprometido con afección del SNC.

We report a 16 years old boy with diagnosis of Acute Myeloid Leukemia with severe immune suppression secondary to his primary disease and to leukemia's treatment. Early during the course of his chemotherapy he developed symptoms and signs compatible with invasive fungal disease (IFD). Lungs were primarily compromised followed by CNS involvement with manifestations of intracranial hypertension. Laboratory exams were remarkable for prolonged neutropenia and indirect evidence of Aspergillus sp infection, with successive detection of positive and increasing levels of galactoman antigen in serum. With this case we want emphasize the great importance of invasive fungal disease in immune suppressed patients and particularly the CNS compromise. This represents a medical emergency which deserves to start a complete and comprehensive microbiology diagnosis and concomitantly start an empiric antifungal treatment. The importance of neuroimaging for a correct identification of the number, location and size of CNS lesions must be highlighted. The election of MRI, if available, should be preferred due to a better performance than CT scan. Brain biopsy should be discussed when all the non invasive attempts for etiology identification have failed. The invasive fungal CNS compromise has medical treatment and the surgical drainage has to be considered for lesions greater than 2 cm or for those making a mass effect or have failed with medical treatment.

[Hantavirosis: clinical and epidemiological characteristics of pediatric patients in Chile]. / Hantavirosis: Caracterización clínica-epidemiológica de pacientes pediátricos en Chile.

BACKGROUND: The first cases of Hantavirus cardiopulmonary syndrome in children were described in the United States and represented 8% of the total reported cases; in Chile, the proportion of pediatric cases represents 15% of all national cases. AIM: To describe the epidemiology and clinical course of 82 children reported to the Chilean Ministry of Health up to 2007 and to characterize more extensively a subgroup of 24 children whose detailed clinical data were available. RESULTS: Forty patients were under 10 years old. Seventeen (17/82) of 82 cases (20.7%) presented in the context of a family cluster. Ninety eight percent of cases (80/82) occurred among individuals living in rural areas and 66% during summer months). The overall fatality rate was 36.6%. Fever (93%), respiratory distress (75%) and gastrointestinal symptoms (75%) were the most frequent symptoms encountered in the 28 children studied more extensively. Abnormal blood coagulation test were significantly associated with death while an increased hematocrit was associated with severe cases (hemodynamic unstability). CONCLUSION: An early diagnosis should favor early onset of aggressive treatment that could potentially save lives. Increasing knowledge on the clinical presentation of the disease in children should improve early clinical diagnosis among health care professionals.

[Clinical characteristics of respiratory infection due to Mycoplasma pneumoniae in hospitalized children]. / Características clínicas de la enfermedad respiratoria causada por Mycoplasma pneumoniae en niños hospitalizados.

INTRODUCTION: Studies on Mycoplasma pneumoniae infection are scarce in Chile. OBJECTIVE: To describe clinical characteristics associated with M. pneumoniae in children requiring hospitalization. MATERIAL AND METHODS: All children with a respiratory infection requiring hospitalizations between 2000-2005, whom had a M. pneumoniae specific IgM > or = 1:32, were analyzed. RESULTS: Fifty children meeting study criteria were identified with an average length of hospitalization of 4 days (range: 1-10); mean age was 5.4 years (46% were younger than 5 years). Common clinical features were cough (92%), fever (82%), malaise (74%) and respiratory distress (72%). At admission 40/45 children had hypoxemia. Chest-X ray showed interstitial pattern (69.3%), consolidation (51%) and hyperinsuflation (28.5%). Six patients had pleural effusion. Eighty four percent of patients had a favorable clinical outcome; eight children required admission to the PICU all of whom recovered. CONCLUSION: Respiratory infections associated with M. pneumoniae in our series of children had a highly variable and non-specific clinical spectrum. Chest-X rays showed different pattern in concordance with previous publications.

[Sociodemographic risk factors of hantavirus cardiopulmonary syndrome]. / Factores de riesgo socio-demográficos del síndrome cardiopulmonar por hantavirus.

BACKGROUND: Hantavirus cardiopulmonary syndrome (HCPS) is caused by new world hantaviruses, among which Andes hantavirus (ANDV) is endemic to Chile and Southern Argentina. The disease caused by ANDV produces plasma leakage leading to enhanced vascular permeability and has a high case fatality rate (35%), mainly due to respiratory failure, pulmonary edema and myocardial dysfunction, hypoperfusion and shock. Host sociodemographic and genetic factors might influence the course and outcome of the disease. Yet, they have not been thoroughly characterized. AIM: To evaluate sociodemographic factors as risk factors in severity of HCPS. PATIENTS AND METHODS: Study period: 2004-20013, attending in eight collaborative centers, etiological diagnosis was performed by serology or molecular biology, mild and severe HCPS were compared.139 Chilean patients were analyzed, 64 (46%) with severe disease among which 12 (19 %) died. RESULTS: European ethnicity had 5,1 times higher risk than Amerindian ethnic group to develop a severe HCPS, greater seriousness that was also associated with an urban residence. CONCLUSION: It was observed that ethnicity and type of residence were significant risk factors for HCPS severity. Hypotheses explaining these findings are discussed.

[Clinical and epidemiological manifestations of parainfluenza infection in hospitalized children]. / Características clínicas y epidemiológicas de la infección por virus parainfluenza en niños hospitalizados.

BACKGROUND: Human parainfluenza viruses (hPIV) are a common cause of respiratory illness of children but published data on clinical characteristics of hPIV infection in South America is scarce. OBJECTIVE: To review the clinical presentation and epidemiological features of hPIV in a series of hospitalized children in Chile. PATIENTS AND METHODS: Retrospective review of clinical charts from all pediatric admissions with a diagnosis of respiratory disease (between January 2001 to December 2004) at the Catholic University Hospital, Santiago, Chile. Nasopharyngeal secretions were tested for hPIV in children admitted with suspected respiratory viral infections. RESULTS: A total of 3,043 respiratory admissions were recorded during the study period; 64 children (2.1%) were hPIV positive. Average age was 13 months (range: lm to 12y) and 77%> were younger than 2 years. HPIV-2 was the most common type identified (47%). A seasonal trend was noted for serotypes hPIV-2 and 3. Acute wheezing (40%o) and pneumonia (30%) were the most common clinical diagnosis in hPIV positive children and 17%> hPIV positive children (44%> for hPIV-1) were associated with laryngitis. All hPIV positive bronchiolitis were due to serotypes hPIV-2 and 3. CONCLUSION: hPIV can cause respiratory disease requiring hospitalization; serotypes hPIV-2 and 3 displayed a seasonal trend. Although hPIV is an uncommon cause of severe respiratory infecion requiring hospitalization in children, it should be considered in the differential diagnosis of laryngitis, bronchiolitis and pneumonia, especially in younger children.

[Bacillary angiomatosis caused by Bartonella quintana in an human immunodeficiency virus positive patient]. / Angiomatosis bacilar por Bartonella quintana en un paciente con infección por virus de inmunodeficiencia humana.

We report the first case of bacillary angiomatosis due to Bartonella quintana affecting a Chilean a HIV positive patient in Chile. He was a 27 years old, heterosexual male, indigent man known to be HIV positive serological status known from September, 2003, under irregular medical control. On April, 2005, he presented a progressive abscess in the frontal region and erythematous papules in the extremities, that extended to face, thorax and mucoses, becoming nodular and violaceous lesions. Bacillary angiomatosis diagnosis was initially sustained on account of the clinical manifestations, and was confirmed by serology and Warthin Starry staining from a skin biopsy. The etiological agent was identified as Bartonella quintana through universal RPC performed from a cutaneous nodule to detect 16S rRNA gen. Azithromycin plus ciprofloxacin was started, besides of anti retroviral therapy antiretroviral, with the lesions being progressively disappearing.

[Human metapneumovirus as hospitalization cause in children under 3 years old with acute respiratory infections during 2004]. / Metapneumovirus humano como causa de hospitalización en niños bajo 3 años de edad, con infección respiratoria aguda, durante el año 2004.

Human metapneumovirus was detected in 15 of 123 children (12%) younger than 3 years of age hospitalized for treatment of acute respiratory infection between July and November 2004. The virus was detected by RT-PCR directly from nasopharyngeal swabs and/or from supernatants after cell culture. Children infected with hMPV were mostly younger than one year of age (67%), all presenting with fever and cough. The main cause for hospitalization was the need for oxygen therapy (73%). Four hMPV positive children had an identifiable co-morbid condition but had a similar clinical evolution when compared to previously healthy infants. Chest radiography showed an increase in interstitial infiltrates with focal consolidation in 6 children. Obstructive bronchial syndrome and bronchiolitis, with or without pneumonia, were the most frequent diagnosis associated with hMPV positivity. A rapid and sensitive diagnostic method is required to improve diagnosis and treatment of these patients.

[Genetic susceptibility to Andes Hantavirus: Association between severity of disease and HLA alíeles in Chilean patients]. / Susceptibilidad genética a hantavirus Andes: Asociación entre la expresión clínica de la infección y alelos del sistema HLA en pacientes chilenos.

Andes hantavirus (ANDV) infection in Chile has a variable clinical expression, and infected individuals may present with different grades of disease severity. This study aimed to determine if clinical expression of ANDV infection in Chilean patients is associated with the HLA system. HLA alíeles A, B, DRB1 and DQB1, were studied in two groups of patients with confirmed ANDV infection: 41 patients with a mild disease course (without respiratory failure and cardiovascular shock) and 46 patients with a severe disease course (with respiratory failure and shock). Molecular typing of HLA system was performed by SSP-PCR. The HLA-DRB 1*15 alíele, was significantly more common in the group of patients with mild disease (p = 0,007) and thus for possibly associated with a protective effect against ANDV infection. Conversely, HLA-B*08 was more common in patients with severe disease (p = 0,06). Although the association was marginally significant, alíele HLA-B*08 may be linked to an increased susceptibility to the severe clinical course of HCPS by ANDV.

[Clinical and epidemiological characteristics of respiratory virus infections among adults hospitalized during 2004 influenza season]. / Perfil clínico-epidemiológico de las infecciones por virus respiratorios en adultos hospitalizados durante la estación de influenza 2004.

BACKGROUND: During yearly influenza (FLU) season, FLU viruses are well represented among hospitalized patients as in the community. Also, other respiratory viruses could be represented among adult in-patients. AIM: to describe the presence and clinical- epidemiological characteristics of non-FLU respiratory virus infections (respiratory syncytial-RSV, parainfluenza and adenovirus-ADV) among hospitalized adults during FLU season and to compare with FLU-A (IA) or -B (IB) cases. PATIENTS AND METHODS: Adult patients hospitalized at Hospital Clínico Universidad Católica between May to July 2004 with a respiratory virus infections confirmed by rapid antigen test or direct immunofluorescence of IA, IB (Flu group) or RSV, parainfluenza (1-2-3) and ADV (non-Flu group) were included. RESULTS: 86 cases were identified: 73.5% FLU (48.2% IA, 25.3% IB) and 26.5% non-FLU (15.7% parainfluenza-2; 8.4% RSV; 1.2% parainfluenza-3; 1.2% ADV). No differences were observed in general characteristics and evolution of patients. In FLU-group were more frequently observed myalgia, cough, hospitalization due to febrile syndrome, higher values of C-reactive protein and band leukocytes count (p < 0.05). CONCLUSIONS: During 2004 FLU season a 26.5 % of respiratory viral infection were due to non-FLU viruses among adult hospitalized in our centre. The difficulty to difference FLU vs. non-FLU infections, suggest that it is necessary to include other respiratory virus in the viral etiological diagnosis, even in FLU season.

Manifestaciones otorrinolaringológicas en la infección por virus de inmunodeficiencia humana

Resumen La infección por el virus de la inmunodeficiencia humana (VIH) es una pandemia global que afecta a 38 millones de personas en el mundo. En Chile, se ha visto un alza sostenida en la incidencia de VIH, aumentando un 57% entre 2010 y 2019, reportándose 74.000 personas que viven con VIH en el país. Las manifestaciones en cabeza y cuello ascienden a un 80% de los pacientes con VIH. Éstas pueden presentarse durante el síndrome retroviral agudo, en etapas más avanzadas, incluso como forma de debut, o aparecer en casos de falla de tratamiento o complicaciones derivadas del síndrome inflamatorio de reconstitución inmune. Con la mayor cobertura de terapia antirretroviral (TARV) se ha visto a lo largo del tiempo un cambio en la frecuencia de las manifestaciones otorrinolaringológicas. Las lesiones de la cavidad oral han representado un signo de avance de la enfermedad o de falla al tratamiento, siendo más frecuentes la candidiasis y la leucoplasia vellosa. En el área rinosinusal predominan la rinitis y rinosinusitis, en el cuello las linfadenopatías e hipertrofia parotídea, y en el oído la hipoacusia, alteraciones vestibulares y del oído medio. Para la especialidad de otorrinolaringología es fundamental conocer estas manifestaciones para mantener un alto índice de sospecha del diagnóstico. De esta forma, se permite un diagnóstico precoz y tratamiento oportuno para así mejorar la calidad de vida del paciente. Además, se requiere un seguimiento cercano de forma de detectar signos tempranos de falla al tratamiento o progresión a etapas más avanzadas.

Abstract The human immunodeficiency virus (HIV) infection is a global pandemic, affecting 38 million people worldwide. In Chile, its incidence has risen continuously, increasing to 57% from 2010 to 2019, with 74,000 infected people in the country. Head and neck manifestations account to 80% of HIV patients. These manifestations may be present during the acute retroviral syndrome, in more advanced stages, even as a debut, or appear in treatment failure or complications secondary to the immune reconstitution inflammatory syndrome. With the increase in antiretroviral therapy (ART) coverage, the prevalence of otorhinolaryngological manifestations has changed. Oral lesions may be an early sign for advanced stages or treatment failure, with a predominance of candidiasis and hairy leukoplakia. Rhinitis and rhinosinusitis are the main manifestations in the sinonasal area, lymphadenopathy and parotid hypertrophy in the neck, and hearing loss, vestibular and middle ear disorders in the ear. It is essential for otorhinolaryngologists to be aware of these manifestations in order to maintain a high index of clinical suspicion, allowing an early diagnosis and opportune treatment to improve the patient's quality of life. In addition, a close follow-up is required to identify early signs of treatment failure or progression to more advanced stages.

Factores de riesgo socio-demográficos del síndrome cardiopulmonar por hantavirus / Sociodemographic risk factors of hantavirus cardiopulmonary syndrome

Resumen Introducción: El síndrome cardiopulmonar por hantavirus (SCPH) es causado en Chile y en el sur de Argentina por el Andes hantavirus (ANDV), el que es endémico en esta zona. La enfermedad causada por ANDV produce un aumento de permeabilidad vascular y filtración de plasma con una alta tasa de letalidad (35%), debido principalmente a insuficiencia respiratoria por edema pulmonar y al desarrollo en los casos graves de compromiso miocárdico, hipoperfusión y shock. Aunque se sabe que los factores socio-demográficos del hospedero pueden influir en el curso y el resultado de la enfermedad, estos no se han caracterizado previamente en la población chilena. Objetivo: Evaluar la relación entre los factores socio-demográficos y la gravedad del SCPH. Pacientes y Métodos: Período de análisis 2004-20013, pacientes atendidos en ocho centros colaboradores, diagnóstico etiológico serológico o por biología molecular, se comparan SCPH leve y grave. Se analizaron 139 pacientes chilenos, 64 (46%) con enfermedad grave, entre los cuales 12 murieron (19%). Resultados: La etnia europea tuvo un riesgo 5,1 veces mayor de desarrollar un SCPH grave que la etnia amerindia, gravedad mayor que también se asoció a una residencia urbana. Conclusiones: Se observó una asociación estadísticamente significativa entre etnia, lugar de residencia y evolución de SCPH. Se discuten hipótesis que expliquen estos hallazgos.

Background: Hantavirus cardiopulmonary syndrome (HCPS) is caused by new world hantaviruses, among which Andes hantavirus (ANDV) is endemic to Chile and Southern Argentina. The disease caused by ANDV produces plasma leakage leading to enhanced vascular permeability and has a high case fatality rate (35%), mainly due to respiratory failure, pulmonary edema and myocardial dysfunction, hypoperfusion and shock. Host sociodemographic and genetic factors might influence the course and outcome of the disease. Yet, they have not been thoroughly characterized. Aim: To evaluate sociodemographic factors as risk factors in severity of HCPS. Patients and Methods: Study period: 2004-20013, attending in eight collaborative centers, etiological diagnosis was performed by serology or molecular biology, mild and severe HCPS were compared.139 Chilean patients were analyzed, 64 (46%) with severe disease among which 12 (19 %) died. Results: European ethnicity had 5,1 times higher risk than Amerindian ethnic group to develop a severe HCPS, greater seriousness that was also associated with an urban residence. Conclusion: It was observed that ethnicity and type of residence were significant risk factors for HCPS severity. Hypotheses explaining these findings are discussed.

Aporte de la biología molecular en el diagnóstico de infecciones respiratorias agudas / Contribution of multiplex respiratory molecular panel to the diagnosis of acute respiratory infections

Objective: To assess the performance of multiplex-PCR for diagnosis of respiratory viruses in parallel with direct fluorescence assay (DFA). We assessed the performance and co-infection diagnosis of molecular respiratory panel PCR (MRP-PCR) and DFA in hospitalized and outpatients. Results: 8535 samples were included, 1792 tested by MRP-PCR (46.9% positive) and 6743 by DFA (35.1% positive). MRP-PCR diagnosed co-infection in 21.3% and DFA in 1.8% of the samples. Rhinovirus was the most common virus in any age group. In 210 patients both tests were done; 100 were positive by MRP-PCR and 18 by DFA. Positive concordance value was 6.2%. 85 samples were positive only by MRP-PCR and in 42 of them only novel respiratory viruses were identified. Performance of MRP-PCR was statistically significant compared DFA for traditional respiratory viruses. Discussion: Multiplex PCR has shown better sensitivity, may expand the etiologic spectrum of respiratory infections and detect a higher number of co-infections.

Objetivo: Evaluar la contribución del panel respiratorio molecular por reacción en cadena de la polimerasa-multiplex (PRM-RPC) en paralelo a la de inmunofluorescencia directa (IFD) al diagnóstico de infecciones respiratorias. Analizamos y comparamos el rendimiento y diagnóstico de co-infección de PRM-RPC con IFD en pacientes hospitalizados y ambulatorios. Resultados: Se analizaron 8535 muestras; 1792 por PRM-RPC (46,9% positivas) y 6743 por IFD (35,1% positivas). La co-infección fue 21,3% por PRM-RCP y 1,8% por IFD. El virus más frecuente fue rinovirus a toda edad. Se analizaron 210 pacientes por ambos métodos; resultaron positivas 100 por PRM-RPC y 18 por IFD, concordancia positiva de 6,2%. 85 muestras fueron solo positivas por PRM-RPC, 42 diagnosticaron nuevos virus respiratorios. El rendimiento de PRM-RPC fue significativamente mayor que el de IFD para virus respiratorios tradicionalmente diagnosticados. Conclusiones: La RCP-multiplex tiene mejor sensibilidad, podría expandir el espectro etiológico de infecciones respiratorias y detectar un mayor número de co-infecciones comparado a IFD.

Etiología viral en la neumonía del adulto adquirida en la comunidad en un hospital del sur de Chile / Viral etiology of community acquired pneumonia among adults admitted to a general hospital

Background: There is paucity of information about viral etiology of community acquired pneumonia in adults. Aim: To investigate the viral etiology of pneumonia among hospitalized patients. Material and Methods: All adults with pneumonia that were hospitalized were prospectively enrolled at Puerto Montt hospital. A microbiological and viral assessment was carried out. Viral assessment included direct immunofluorescence of nasopharyngeal aspirates for influenza A and B virus and serum samples obtained during the acute phase of the disease and during convalescence for Hanta virus. Results: Between April 1 2005 and March 31 2006,159 adults aged 62 ± 20 years (58 % males), were admitted to the hospital for pneumonia. Mean hospital stay was 11.9 ± 8.6 days. Four patients had Hantavirus acute infection. Other viruses were identified in twelve patients (7.7%). Nine had influenza A, one syncytial respiratory virus, one syncytial and influenza A virus and one varicella zoster virus. Excluding patients with Hantavirus, no significant differences in age, clinical presentation, chest X ray findings, laboratory results and mortality were observed between patients with bacterial or viral etiology of the pneumonia. Conclusions: Viral etiology was confirmed in 10% of adult patients hospitalized with community acquired pneumonia.

Importancia de las imágenes y el diagnóstico etiológico en el paciente inmunocomprometido con afección del sistema nervioso central: Tercera parte / Importance of images and etiological diagnosis in immunocompromised patients with central nervous system involvement: Third part

A twenty four year-old male patient with a history of morbid obesity and acute lymphocytic leukemia diagnosed in 2003, underwent an autologous bone marrow transplantation the same year. He had two relapses of leukemia on 2003 and 2007. On January 2009, he underwent a double cord bone marrow transplantation with myeloablative conditioning and craneospinal radiotherapy. The patient received prophylaxis with aciclovir, cotrimoxazole and fluconazole. The latter was changed afterwards to posaconazole. On day 16 post-transplantation, fever and menin-geal signs appeared. The cerebrospinal fluid exam revealed pleocytosis with polymorphonuclear predominance. Empirical therapy was started with meropenem. Due to neurological impairment, at day 33, a brain magnetic resonance imaging (MRI) was performed, showing multiple hypodense supra and infratentorial nodules with peripheral edema. Biopsy, universal PCR for fungi and a new cerebrospinal fluid analysis were performed and amphotericin B was added showing a favorable response. He was discharged with itraconazole, as the universal PCR of brain tissue revealed Penicillium spp. This is the third report presented in this journal that stresses the importance of early neuroimaging, especially MRI to certify the involvement of the central nervous system in immunocompromised patients.

Paciente de 24 años, sexo masculino, con antecedente de obesidad mórbida que debutó con una leucemia linfática aguda (LLA) en el año 2003. Se le efectuó trasplante (Tx) de precursores hematopoyéticos, autólogo, recayendo el mismo año. En el año 2007 presentó una segunda recaída por lo que se le sometió a Tx doble de cordón como rescate en enero de 2009, con acondicionamiento mieloablativo y radioterapia cráneo-espinal recibiendo profilaxis con aciclovir, cotrimoxazol y fluconazol, el que fuera cambiado posteriormente a posaconazol. El día 16 post trasplante presentó fiebre y signos meníngeos, con LCR que revelaba una pleocitosis de predominio polimorfonuclear. Se inició terapia empírica con meropenem. Debido al deterioro neurológico, en el día 33, se le efectuó una resonancia magnética cerebral (RM) donde se evidenciaron múltiples nódulos hipodensos supra e infratentoriales con edema periférico. Se le realizó biopsia cerebral, cultivos, reacción de polimerasa en cadena (RPC) para hongos, nuevo estudio de LCR completo y se agregó anfotericina B deoxicolato presentando una respuesta favorable. Finalizada la terapia con anfotericina B se dio de alta con itraconazol ya que la RPC de tejido cerebral reveló Penicillium sp. Este es el tercer caso presentado en esta revista en los que enfatizamos la importancia de las neuroimágenes, en especial la RM, realizadas en forma precoz para certificar el compromiso del SNC en pacientes inmunocomprometidos.

Importancia de las imágenes y el diagnóstico etiológico en el paciente inmunocomprometido con afección del sistema nervioso central: Segunda parte / Importance of images and etiological diagnosis in the immunocompromised patient with central nervous system envolvement: Part II

We present the case of a 12-year-old boy with acute lymphocytic leukemia who developed pneumonia and multiple brain infarcts compatible with acute necrotic encephalitis. The infectious disease screening tests revealed influenza A H1N1 virus, Staphylococcus aureus in broncho alveolar lavage, E. coli and galactomannan antigen in blood. CNS influenza associated complications are reviewed. This case highlights the importance of magnetic resonance imaging as a diagnostic tool in the assessment of immunocompromised patients with CNS compromise and the value of brain biopsy in the final identification of an infectious disease etiology.

Escolar de 12 años de edad, con Leucemia Linfocítica Aguda en tratamiento que desarrolla una bronconeumonía bilateral, infartos cerebrales compatibles con encefalitis necrosante aguda. El estudio infectológico demostró más de una causas infecciosa que pudiera explicar su evolución destacando influenza A H1N1, Staphylococcus aureus meticilina sensible en lavado bronco alveolar, E. coli y galactomanano en sangre. Se revisa el compromiso del SNC por influenza A H1N1. Se destaca la importancia del uso de resonancia magnética nuclear al evaluar pacientes inmunocomprometidos con complicaciones neurológicas y el aporte de una biopsia cerebral en aclarar la etiología de este compromiso.

Influenza pandémica A (H1N1) 2009: epidemiología, características clínicas y diferencias con influenza estacional en Chile / Pandemic influenza A (H1N1) 2009: epidemiology, clinical features and differences with seasonal influenza in Chile

Pandemic influenza A (H1N1) 2009 raised questions regarding differences with seasonal influenza. Objectives: To describe the clinical features of pandemic influenza and compare them to seasonal influenza. Patients y Methods: A descriptive study that compared hospitalized adults was done between patients with confirmed pandemic inluenza in the Hospital Clínico Universidad Católica in Santiago, Chile, from May to July 2009 and 95 confirmed historic cases of seasonal influenza. Results: 54 patients with pandemic influenza were included, 51.9 percent were male, age of 52.8 ± 19.5 years old; 79.6 percent had chronic diseases; 16.7 percent were immunocompromised patients and 7.4 percent of pregnant women. 25.9 percent of the patients acquired the infection during the hospitalization. 31.5 percent were admitted to intermediate/intensive care units. Pneumonia was diagnosed in 37 percent, and the mortality rate was 3.7 percent. The comparison between pandemic and seasonal influenza showed less proportion of patient > 65 years of age (31.5 percent vs. 68 percent; p < 0.0001); double number of nosocomial acquisition and more cases of pneumonia and death. Conclusions: The pandemic inluenza infection affected younger people and was related with more nosocomial cases, pneumonia and mortality rates than seasonal inluenza.

La pandemia de inluenza A (H1N1) 2009 generó preguntas sobre sus diferencias con influenza estacional. Objetivos: Describir las características de influenza pandémica y comparar con influenza estacional. Pacientes y Métodos: Estudio descriptivo de casos confirmados de influenza pandémica en adultos internados en el Hospital Clínico de la Pontificia Universidad Católica entre mayo y julio de 2009, comparado con 95 casos históricos de influenza estacional. Resultados: 54 pacientes con influenza pandémica, 51,9 por ciento género masculino, edad 52,8 ± 19,5 años; 79,6 por ciento presentaban co-morbilidades; 16,7 por ciento inmunocomprometidos, 7,4 por ciento mujeres embarazadas, 25,9 por ciento de adquisición nosocomial, 31,5 por ciento requirió cuidados intensivos/intermedios. Se diagnosticó neumonía en 37 por ciento y la mortalidad global fue 3,7 por ciento. En la comparación con inluenza estacional, la pandémica afectó menos pacientes > de 65 años (31,5 vs 68 por ciento, p < 0,0001), dobló los casos con adquisición nosocomial y hubo más casos de neumonía y muertes. Conclusiones: La infección por inluenza pandémica afectó a un grupo de menor edad y generó mayor transmisión nosocomial, neumonía y muerte que la inluenza estacional.