Infección rinosinusal por Scedosporium apiospermum en un hospedero inmunocompetente / Scedosporium apiospermum rhinosinusal infection in an immunocompetent host

Scedosporium species can cause colonization, superficial and deep localized infection or systemic disease, espe-cially in irnmunocompromised hosts. We report a case of localized infection due to Scedosporium apiospermum in a 47 year oíd woman, with previous nasal surgery. She consulted for recurrent mucopurulent post-nasal discharge not responding to antibiotics. Computed tomography showed opacification of right maxillary sinus. Surgery was performed to removed abnormal tissue from sinus; biopsy revealed chronic sinusitis with aggregate of tightly packed hyphae suggestive of filamentous fungi. The microbiology fungal culture reported Scedosporium apiospermum.

Las infecciones por Scedosporium sp pueden traducirse en colonización, infecciones localizadas superficiales y profundas, o enfermedad diseminada. Presentamos un caso clínico de infección rinosinusal por Scedosporium apiospermum en una paciente de 47 años, con antecedente de cirugía por cuerpo extraño en la fosa nasal derecha. Consultó por descarga posterior muco-purulenta y recurrente, sin respuesta a tratamiento antibacteriano. Las imágenes de cavidades paranasales mostraron opacidad del seno maxilar derecho. Se realizó cirugía de remoción de contenido sinusal cuyo estudio histológico reveló sinusitis crónica erosiva, colonias de hongos con morfología sugerente de hongo filamentoso y desarrollo de S. apiospermum en el cultivo.

[Multicenter study on the monitoring of in vitro susceptibility to tigeeyeline in Santiago, Chile]. / Estudio multicéntrico de la vigilancia de la susceptibilidad in vitro a tigeciclina en Santiago de Chile.

The objective of this multicenter study was to determine tigecycline susceptibility rates, measured by agar diffusion, in nine hospitals in Santiago and to compare these rates with other antimicrobials. Each center studied 20 strains per month. All intermediate and fully resistant strains as well as 10% of susceptibile strains were also studied by the broth microdilution method. Overall, 2301 strains were studied displaying the following susceptibility rates for tigecycline: 100% for Streptococcus sp, Enterococcus sp, and E. coli respectively, 99.8% for Staphylococcus sp, 93% for Klebsiella and 80% for Acinetobacter baumarmii. For Proteus, Providencia and Morganella the susceptibility rates were 4%. For cefotaxime-resistant Klebsiella and imipenem-resistant A. baumarmii susceptibility rates were 95% and 80% respectively. The agar diffusion and broth dilution method were 100% concordant for tigecycline susceptible strains but only 27% for resistant or intermediate strains represented mostly by Acinetobacter baumannii. The majority of these strains (57/59) proved to be susceptible after retesting. The great majority (96,6%) of strains tested from nine Chilean hospitals proved to be susceptible to tigecycline with exception for Proteus, Providencia and Morganella (66% resistance). Using the agar diffusion method for measuring tigecycline susceptibility to A. baumannii may be misleading.

Estudio multicéntrico de la vigilancia de la susceptibilidad in vitro a tigeciclina en Santiago de Chile / Multicenter study on the monitoring of in vitro susceptibility to tigeeyeline in Santiago, Chile

The objective of this multicenter study was to determine tigeeyeline susceptibility rates, measured by agar diffusion, in nine hospitals in Santiago and to compare these rates with other antimicrobials. Each center studied 20 strains per month. All intermedíate and fully resistant strains as well as 10 percent of susceptibile strains were also studied by the broth microdilution method. Overall, 2301 strains were studied displaying the foliowing susceptibility rates for tigeeyeline: 100 percent for Streptococcus sp, Enterococcus sp, and E. coli respectively, 99.8 percent for Staphylococcus sp, 93 percent for Klebsiella and 80 percent for Acinetobacter baumarmii. For Proteus, Providencia and Morganella the susceptibility rates were 4 percent. For cefotaxime-resistant Klebsiella and imipenem-resistant A. baumarmii susceptibility rates were 95 percent and 80 percent respectively. The agar diffusion and broth dilution method were 100 percent concordant for tigeeyeline susceptible strains but only 27 percent for resistant or intermedíate strains represented mostly by Acinetobacter baumannii. The majority of these strains (57/59) proved to be susceptible after retesting. The great majority (96,6 percent) of strains tested from nine Chilean hospitals proved to be susceptible to tigeeyeline with exception for Proteus, Providencia and Morganella (66 percent resistance). Using the agar diffusion method for measuring tigeeyeline susceptibility to A. baumannii may be misleading.

Para conocer la susceptibilidad a tigeciclina por difusión en agar en nueve hospitales de Santiago y comparar la susceptibilidad con otros antimicrobianos, se diseñó este estudio multicéntrico. Cada centro estudió 20 cepas mensualmente. Las intermedias, resistentes y 10 por cientoo de las susceptibles se re-testearon y estudiaron por microdilución en caldo. Se incluyeron 2.304 cepas. Fueron susceptibles a tigeciclina Strep-tococcus sp (100 por cientoo), Enterococcus sp (100 por ciento), E. coli (100 por cientoo), Staphylococcus sp (99,8 por ciento), Klebsiella pneumoniae (93 por ciento) y Acinetobacter baumannii (80 por ciento). En Proteus, Providencia y Morganella la susceptibilidad fue 4 por cientoo. Klebsiella resistente a cefotaxima y Acinetobacter resistente a imipenem, 95 por cientoo y 80 por cientoo fueron susceptibles a tigeciclina, respectivamente. La concordancia en cepas susceptibles y en las enviadas como resistentes o intermedias (A. baumannii) fue 100 por cientoo y 27 por cientoo respectivamente. El re-testeo confirmó que la mayoría eran susceptibles. Los patrones de susceptibilidad bacteriana muestran muy buena actividad in vitro a tigeciclina. La resistencia in vitro de A. baumannii por difusión en agar debe interpretarse con precaución.

[Primary Listeria monocytogenes infection in a cirrhotic woman: report of one case]. / Bacteriemia primaria por Listeria monocytogenes en paciente con cirrosis hepática: Caso clínico.

L. monocytogenes infections are infrequent. Sepsis in pregnant women and newborns and central nervous system infections in the elderly are the most common clinical manifestations. We report a 61 years old woman with diabetes Mellitus and a Child B hepatic cirrhosis, admitted for persistent fever. Blood cultures were positive for Listeria monocytogenes. Cerebrospinal fluid was normal and sterile. She was treated with ampicillin and amikacin with a good response. Control blood cultures were negative. She was discharged 14 days after in good conditions.

Bacteriemia primaria por Listeria monocytogenes en paciente con cirrosis hepática: Caso clínico / Primary Listeria monocytogenes infection in a cirrhotic woman: Report of one case

L. monocytogenes infections are infrequent. Sepsis in pregnant women and newborns and central nervous system infections in the elderly are the most common clinical manifestations. We report a 61 years old woman with diabetes Mellitus and a Child B hepatic cirrhosis, admitted for persistent fever. Blood cultures were positive for Listeria monocytogenes. Cerebrospinal fluid was normal and sterile. She was treated with ampicillin and amikacin with a good response. Control blood cultures were negative. She was discharged 14 days after in good conditions.

[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.

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

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, indigentman 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.

Reportamos el primer caso de angiomatosis bacilar por Bartonella quintana en un paciente con infección por VIH en nuestro país. Este corresponde a un hombre de 27 años, heterosexual, indigente, seropositivo para VIH conocido desde septiembre de 2003, en control irregular. En abril de 2005, el paciente desarrolló un aumento progresivo de volumen en la región frontal y aparición de pápulas eritematosas en las extremidades, que luego se extendieron a la cara, tórax y mucosas, tornándose nodulares y violáceas. El diagnóstico de angiomatosis bacilar se planteó inicialmente por el cuadro clínico del paciente, siendo confirmado por serología y tinción de Warthin Starry positiva en la biopsia de piel. El agente causal se identificó como Bartonella quintana por RPC universal para el gen del 16S ARNr de un nódulo cutáneo. Se inició terapia antimicrobiana con azitromicina y ciprofloxacina, además de terapia antiretroviral, con desaparición de las lesiones en forma progresiva.

Presencia de Bartonella henselae en gatos: cuantificación del reservorio natural y riesgo de exposición humana de esta zoonosis en Chile / Presence of Bartonella henselae in cats, in Chile

Background: The availability of a serologic test for cat scratch disease in humans has allowed the diagnosis of an increasing number of cases of this disease in Chile. Aim: To perform a serological survey for Bartonella henselae among cats in Chile. Material and methods: Blood samples from 187 cats living in three Chilean cities were obtained. IgG antibodies againts Bartonella henselae were measured using indirect immunofluorescence. Blood cultures were done in 60 samples. The presence of Bartonella henselae in positive cultures was confirmed by restriction fragment length polymorphism polimerase chain reaction (RFLP-PCR). Results: The general prevalence of IgG antibodies against Bartonella henselae was 85.6%. No differences in this prevalence were found among cats younger or older than 1 year, or those infested or not infested with fleas. However domestic cats had a lower prevalence when compared with stray cats (73 and 90% respectively, p <0.01). Bartonella henselae was isolated in 41% of blood cultures. All the isolated were confirmed as Bartonella henselae by RFLP-PCR. Conclusions: This study found an important reservoir of Bartonella henselae in Chilean cats and therefore a high risk of exposure in humans who have contact with them.

Evaluación de la tinción de Hucker para la búsqueda rutinaria de Campylobacter sp en el estudio de un síndrome diarreico agudo / Evaluation of Hucker stain as Campylobacter sp screening detection during an acute diarrhea disease

La infección por Campylobacter sp es una de las etiologías más comunes de gastroenteritis en el mundo, y en Chile ocuparía el tercer lugar entre las diarreas bacterianas en lactantes, según estudios previos. En nuestro país el cultivo no se realiza rutinariamente por su alto costo económico, siendo conocido que la tinción de Hucker puede ser una buena alternativa de pesquisa. El objetivo del estudio fue conocer la utilidad de la tinción de Hucker y estimar la frecuencia de Campylobacter sp en muestras de deposiciones. Se estudiaron 5.750 muestras de coprocultivos recibidas en el Labo-ratorio de Microbiología de la Red de Salud UC entre marzo del 2002 y mayo del 2004, en las cuales se realizó coprocultivo convencional y tinción de Hucker. Para la validación de la tinción de Hucker con el cultivo se sembró durante un mes todas las muestras para la búsqueda de Campylobacter sp, encontrando una sensibilidad de 37,5% y especificidad de 100%. En 115/5.750 muestras (2%) se observaron bacilos curvos sugerentes de Campylobacter sp por tinción de Hucker y se aislaron otros 233 entero patógenos (4%) que correspondieron a: Salmonella sp (151), Shigella sp (55), Escherichia coli enterohemorrágica (25) y Yersinia sp (2). De las tinciones de Hucker positivas 62,6% correspondieron a niños bajo 5 años y de éstas 63,8% a lactantes. Concluimos que la tinción de Hucker en un método sencillo y específico, aunque poco sensible, que permite aumentar el rendimiento de la detección microbiológica de patógenos entéricos en 33%. En este estudio, Campylobacter sp ocupó el segundo lugar después de Salmonella sp en muestras de deposiciones enviadas para cultivo, concentrándose en edades tempranas de la vida. La búsqueda activa de Campylobacter sp por medio del cultivo específico es fundamental para el diagnóstico etiológico de un síndrome diarreico agudo.

[Evaluation of Hucker stain as Campylobacter sp screening detection during an acute diarrhea disease]. / Evaluación de la tinción de Hucker para la búsqueda rutinaria de Campylobacter sp en el estudio de un síndrome diarreico agudo.

Campylobacter infection is one of the most frequent causes of gastroenteritis in the world and the third in Chile according to some studies. The routinary culture for Campylobacter in our country is not performed because of its high cost, and it is known, that the Hucker stain is a reasonable screening alternative. The objective of this study was to know the utility of the Hucker stain and estimate the frequency of Campylobacter in stool samples. A total of 5,750 stool samples received in the Catholic University Health Net Microbiology Laboratories, from March 2002 to May 2004, were studied with conventional stool culture and Hucker stain. In order to validate the Hucker stain with culture, during one month, all the stool samples were also studied with Campylobacter culture, with 35% sensitivity and 100% specificity. In 115/5.750 samples (2%), curved bacilli suggesting Campylobacter were observed by Hucker stain, and another 233 enteropathogens (4%) which corresponded to: 151 Salmonella sp, 55 Shigella sp, 25 enterohemorrhagic E coli, and 2 Yersinia sp were isolated. When analyzing the patients in whom the Hucker stain was positive, 62.2% were younger than 5 years and of these, 63.8% were infants. We conclude that the Hucker stain is a simple and specific method, although not very sensitive, that allows us to increase the yield of diagnosing enteric pathogens in a 33%. Campylobacter sp was in the second place after Salmonella sp in stool samples, and most frequent in young children. The active search for Campylobacter by means of culture is fundamental in the diagnosis of acute diarrhea.

Evaluación del rendimiento del coprocultivo en pacientes hospitalizados / Utility of stool culture in inpatient

Estudios han mostrado que es inapropiado realizar coprocultivos (CP) en pacientes con más de tres días de hospitalización, dado que la causa de diarrea no es atribuible a los patógenos entéricos que habitualmente se buscan en este examen1-3. El objetivo de este trabajo es analizar el rendimiento de los CP realizados en pacientes hospitalizados en la Red de Salud UC desde enero a diciembre del 2002 y la proporción de resultados positivos obtenidos según los días de hospitalización, para así poder definir si las normas internacionales se adaptan a la realidad nacional. Se recibieron 3474 CP, de los cuales 458 (13,2%) provenían de pacientes hospitalizados. De éstos, 16 (3,5%) fueron positivos, 13 se tomaron el día del ingreso, 2 al segundo día y 1 al quinto día de hospitalización. El rendimiento de CP realizados en pacientes con más de dos días de hospitalización fue sólo de 0,5% (1/190). Los resultados encontrados reafirman la recomendación internacional de no solicitar CP en pacientes con más de tres días de hospitalización; e incluso, a la luz de los datos anteriores, se podría sugerir instaurar un punto de corte a los 2 días de hospitalización, ya que más allá de este tiempo no hay un impacto clínico significativo y podríamos ahorrar un 41% de estos exámenes, con los costos correspondientes.

Toxocariasis en adulto manifestada como síndrome hipereosinofílico con compromiso neurológico predominante: caso clínico / Toxocariasis manifesting as an hypereosinophilic syndrome with predominant neurological involvement: report of adult case

Hypereosinophilic syndrome is characterized by persistent hypereosinophilia and signs or symptoms due to organ involvement, specially nervous system, heart and skin. It can be primary or secondary to allergies, parasites or cancer. Toxocariasis is an uncommon parasitic disease in adults. There is a variant, called visceral larva migrans, that can involve different organs, and among those, the central nervous system. We report a 61 years old male, with a cerebrovascular disease. There were focalizing symptoms, the CAT scan showed multiple ischemic lesions and a peripheral eosinophilia of 12152 cells/mm3 was present. Anti toxocara IgG antibody titers were 1/1000. The patient was treated with albendazole for 14 days. After a 2 years follow up the patients is in good conditions and, for the first time, his eosinophil count is within normal limits