[Clinical and epidemiological features of leptospirosis in Bolívar state, Venezuela. Comparison of diagnostic methods: LEPTO-Dipstick and plaque macroscopic agglutination test]. / Aspectos epidemiológicos y clínicos de la leptospirosis en el estado Bolívar, Venezuela, 1999-2000. Comparación de LEPTO-Dipstick y antígeno termorresistente de Leptospira (TR).

Leptospirosis is caused by numerous serovars of Leptospira interrogans. The infection is acquired through the contact of softened skin, mucous and conjunctive with the urine of animals and humans infected by animal carriers. The aim of this study was to determine the clinical and epidemiological features of leptospirosis in Bolívar state Venezuela and to compare the sensibility and specificity of the LEPTO-Dipstick, with the test of macroscopic agglutination in plate with the termorresistent antigen (TR). Thirty one sample of serums were processed of patients with leptospirosis clinic, admitted in the Hospital Universitario "Ruiz y Páez" of Ciudad Bolívar during 12 months. Detection IgM antibodies of anti-Leptospiras was carried out by means of LEPTO-Dipstick and antigen TR. The Microscopic Agglutination Test (MAT) was also, carried out. The general prevalence of leptospirosis in patients who attended the "Ruiz y Paez" Hospital was of 80.6% (n = 25) by means of the determination of the termorresistent antigen. The most frequent serovars identified in Bolívar State, were the serovars: icterohaemorrhagiae, copenhageni (21.3%), autummalis and australis (12.8%). TR antigen and LEPTO Dipstick had a sensibility of 80% and a specificity of 25%. The agreement between both methods was null (Kappa: -0.2). Bolívar state has a high leptospirosis prevalence and the infection should be discarded in those patients with long-term fever and risk factors for the illness.

Aspectos epidemiológicos y clínicos de la leptospirosis en el estado Bolívar, Venezuela 1999-2000: comparación de LEPTO-Dipstick y antígeno termorresistente de Leptospira (TR) / Clinical and epidemiological features of leptospirosis in Bolívar state, Venezuela comparison of diagnostic methods: LEPTO-Dipstick and plaque macroscopic agglutination test

La leptospirosis es causada por numerosos serovares de Leptospira interrogans. La infección se adquiere por contacto de la piel erosionada o reblandecida, mucosas y conjuntiva, con la orina de animales y/o humanos infectados. El objetivo del presente estudio fue caracterizar los aspectos epidemiológicos y clínicos de la leptospirosis en el estado Bolívar y comparar la sensibilidad, especificidad del LEPTO-Dipstick y el antígeno termorresistente de Leptospira (TR). Durante doce meses consecutivos se tomaron muestras séricas de 31 pacientes con síndrome febril prolongado y clínica compatible de leptospirosis, admitidos en el Complejo Hospitalario Universitario "Ruiz y Páez" de Ciudad Bolívar, Venezuela. La determinación de anticuerpos IgM anti-Leptospira se llevó a cabo utilizando un kit comercial LEPTO-Dipstick y la prueba en placa con el antígeno termorresistente de leptospira (TR) en todas las muestras. Además, se realizó la prueba de aglutinación microscópica (MAT). La prevalencia general de leptospirosis en los pacientes febriles que consultaron al hospital, según el TR, fue del 80,6 por ciento (25/31). Se demostró que los serovares más frecuentes en el Estado Bolívar fueron: icterohaemorrhagiae, copenhageni (21,3 por ciento), autummalis y australis (12,8 por ciento). Se demostró que el antígeno TR y el LEPTO Dipstick tienen una sensibilidad buena (80 por ciento) y especificidad baja (25 por ciento). No hubo concordancia entre ambos métodos (Kappa: -0,2). En el estado Bolívar existe una elevada prevalencia de leptospirosis en pacientes febriles por lo que se debe descartar esta infección en aquellos pacientes que presenten fiebre prolongada y factores de riesgos para la enfermedad

Foliculitis por malassezia spp en un paciente inmunocomprometido / Folliculitis by malassezia spp in an immunocompromised patient

Presentamos el primer caso en nuestro centro hospitalario de foliculitis por Malassezia spp en un paciente diabético con insuficiencia renal crónica quien consultó por presentar lesiones pápulo-pustulosas y nódulos en el cuello y parte superior del tórax, de 15 días de evolución. En el análisis micológico de las lesiones se observaron levaduras incontables redondeadas, globosas y ovales de 1 a 4 µm, algunas con gemación de base ancha sin pseudohifas. El cultivo en agar glucosado de Sabouraud suplementado con aceite de oliva estéril al 1 por ciento mostró crecimiento de colonias de Malassezia spp. El estudio histopatológico mostró una reacción granulomatosa supurativa con destrucción del epitelio folicular. La foliculitis por Malassezia spp debe ser considerada en un paciente inmunocomprometido que no responde a la terapia antimicrobiana

[Vulvovaginitis caused by Candida spp. and Trichomonas vaginalis in sexually active women]. / Vulvovaginitis por Candida spp. y Trichomonas vaginalis en mujeres sexualmente activas.

Vulvovaginitis accounts for 20 to 30% of gynecological diseases and it is observed in women from 20 to 30 years of age. It has a higher frequency in women using oral contraceptives and during the third trimester of pregnancy. The aim of this research was to assess the prevalence of Candida spp and Trichomonas vaginalis in patients with the diagnosis of vulvovaginitis from the Gynecology Service in Hospital Universitario "Ruiz y Páez" in Ciudad Bolívar and Hospital "Raúl Leoni" in San Félix (Bolívar State, Venezuela). Two hundred women with symptoms of vulvovaginitis were examined, and samples were taken from the uterocervical cul-de-sac. Each patient was asked to fill a questionnaire. The following studies were made in each sample: a) fresh wet mount examination, b) orange acridine and Giemsa stains for Trichomonas and c) culture for the identification of yeasts. The latter were identified by means of the germinal tube assay, resistance to actidione and the presence of clamidospores in rice-cream agar and sugar utilization test, using the commercial kit ID32C (BioMérieux). Only in 57 women of 200 patients with vulvovaginitis the causative agent was demonstrated; Candida spp was present in 84.2% (n = 48) and Trichomonas vaginalis in 14% (n = 8). A single case of Zygosaccharomyces spp (1.8%) was detected. The age group mainly affected was that of 25-35 years old, the 38.6% of the studied population. Candida species detected were: C. albicans in 87% of cases (n = 42), C. glabrata, in 10.42% (n = 5), and C. guillermondii, in 2.08 (n = 1). Vaginal flux, vulvar pruritus and leucorrhoea were observed in significant number of patients with vulvovaginal candidiasis. The use of antibiotics was considered predisposing factor for Trichomonas vaginalis infection. The relationship between age and the etiological agent was not statistically significant. Due to the low specificity of clinical manifestations of infections caused by Candida spp and Trichomonas vaginalis, we conclude that performing the etiologic diagnosis of vulvovaginitis is necessary in order to take the appropriate therapeutic and preventive measures, specially in those patients with a recurrent disease.

Vulvovaginitis por Candida spp. y Trichomonas vaginalis en mujeres sexualmente activas / Vulvovaginitis caused by Candida spp. and Trichomonas vaginalis in sexually active women

Vulvovaginitis accounts for 20 to 30 of gynecological diseases and it is observed in women from 20 to 30 years of age. It has a higher frequency in women using oral contraceptives and during the third trimester of pregnancy. The aim of this research was to assess the prevalence of Candida spp and Trichomonas vaginalis in patients with the diagnosis of vulvovaginitis from the Gynecology Service in Hospital Universitario "Ruiz y Pßez" in Ciudad BolÝvar and Hospital "Raúl Leoni" in San FÚlix (BolÝvar State, Venezuela). Two hundred women with symptoms of vulvovaginitis were examined, and samples were taken from the uterocervical cul-de-sac. Each patient was asked to fill a questionnaire. The following studies were made in each sample: a) fresh wet mount examination, b) orange acridine and Giemsa stains for Trichomonas and c) culture for the identification of yeasts. The latter were identified by means of the germinal tube assay, resistance to actidione and the presence of clamidospores in rice-cream agar and sugar utilization test, using the commercial kit ID32C (BioMÚrieux). Only in 57 women of 200 patients with vulvovaginitis the causative agent was demonstrated; Candida spp was present in 84.2 (n = 48) and Trichomonas vaginalis in 14 (n = 8). A single case of Zygosaccharomyces spp (1.8) was detected. The age group mainly affected was that of 25-35 years old, the 38.6 of the studied population. Candida species detected were: C. albicans in 87 of cases (n = 42), C. glabrata, in 10.42 (n = 5), and C. guillermondii, in 2.08 (n = 1). Vaginal flux, vulvar pruritus and leucorrhoea were observed in significant number of patients with vulvovaginal candidiasis. The use of antibiotics was considered predisposing factor for Trichomonas vaginalis infection. The relationship between age and the etiological agent was not statistically significant. Due to the low specificity of clinical manifestations of infections caused by Candida spp and Trichomonas vaginalis, we conclude that performing the etiologic diagnosis of vulvovaginitis is necessary in order to take the appropriate therapeutic and preventive measures, specially in those patients with a recurrent disease.

Sensibilidad de hongos miceliares dematiaceos a diez antifungicos empleando un metodo de difusion en agar / In vitro susceptibiblity of dematiaceous fungi to ten antifungal drugs using an agar difussion test

Se ha evaluado la utilidad del metodo de difusion en agar NeoSensitabs para determinar la sensibilidad in vitro de 52 aislamientos de hongos filamentosos dematiaceos a diez antifungicos: anfotericina B.5-fluorocitosina, Ketoconasol, fluconazol, itraconazol, terbinafina, bifonazol, miconazol, clotrimazol, y griseofulvina. Para la preparacion del inoculo se ultilizo un metodo espectrofotometrico empleandose los medios de Shadomy y Casitone agar (CAS), simultaneamente. Todos los aislamientos fueron sensibles, al itraconazol, terbinafina y bifonazol. Al ketonazol el 90,4% resultaron sensibles al miconazol el 71% y al clotrimazol el 46%. El 63% de las cepas fueron sensibles a la anfotericina B y el 28,8% resistente. Por el contrario, el 94,2% de los aislamientos resultaron resistentes a la griseofulvina y el 96% al flucanazol. El 100% de las cepas fueron resistentes a la 5-fluorocitosina. Las zonas de inhibicion no mostraron variaciones en cuanto a la sensibilidad dependiendo del medio; sin embargo, hubo un mejor desarrollo fungico en el medio CAS. Las variaciones en la sensibiblidad observadas con especies como Exophiala spinifera y Fonsecaea pedrosi justificarian el estudio de la sensibiblidad in vitro para valorar el tratamiento clinico con antifungicos. Estos resultados demuestran que el metodo de difusion en agar NeoSensitabs es facil de realizar, rapido y economico por lo que esta al alcance de muchos laboratorios clinicos para el estudio de la sensibilidad in vitro en mochos dematiaceos