Etiología de la neumonía en pacientes chilenos infectados por el virus de la inmunodeficiencia humana / Etiology of pneumonia in Chilean HIV-infected adult patients

Objectives: To establish the etiology of pneumonia and to compare the yield of diagnostic techniques for diagnosis of Pneumocystis jiroveci and Mycobacterium tuberculosis infections in HIV-1-infected patients. Patients and Methods: Subjects underwent sputum induction and bronchoalveolar lavage (BAL). Gram, Ziehl-Neelsen, silver stain (SS) and immunofluorescense staining (IF) for P. jiroveci, fluorescent stain for mycobacteria, PCR for P. jiroveci andM. tuberculosis, aerobic, fungal and mycobacterial cultures, respiratory viruses and CMV cultures were performed on the sputum and BAL. IgM for Mycoplasma pneumoniae and Chlamydophyla pneumoniae, and Legionella pneumophila urinary antigen were also obtained. Results: Sixty patients were included. An etiologic diagnosis was made in 97 percent. Pneumocystisjiroveci was the most frequent etiology (58 percent) followed by Streptococcus pneumoniae (12 percent), and Mycobacterium avium complex (12 percent). Mycobacterium tuberculosis was found in 5 percent. Conclusions: The comparison of diagnostic methods for P. jiroveci showed a higher sensitivity of IF and SS in BAL than in sputum, however PCR was equally sensitive in both samples. With this approach a precise etiologic diagnosis was reached in the great majority of patients. The most common etiology was P. jiroveci. IF in BAL remains the gold standard for diagnosis of P. jiroveci pneumonia.

Objetivos: Establecer la etiología de la neumonía y comparar el rendimiento de diferentes técnicas para el diagnóstico de las infecciones por Pneumocystis jiroveci y Mycobacterium tuberculosis en pacientes con infección por virus de inmunodeficiencia humana (VIH). Material y Métodos: De cada paciente se obtuvo esputo inducido y se efectuó LBA. A las muestras obtenidas se les realizó tinciones de Gram, Ziehl-Neelsen, plata e inmunofluores-cencia (IF) para P. jiroveci y M. tuberculosis; reacción de polimerasa en cadena (RPC) para ambos microorganismos; cultivos aeróbicos, fúngicos, para micobacterias, virus respiratorios y citomegalovirus. También se realizó determinación de IgM de Mycoplasma pneumoniae y Chlamydophyla pneumoniae y antígeno urinario de Legionella pneumophila. Resultados: Se incluyeron 60 pacientes, lográndose diagnóstico etiológico en 97 por ciento de los casos. Pneumocystis jiroveci fue la etiología más frecuente (58 por ciento), seguida por Streptococcus pneumoniae (12 por ciento) y Mycobacterium avium complex (MAC) (12 por ciento). Mycobacterium tuberculosis fue encontrado en 5 por ciento. Conclusiones: La comparación de los métodos diagnósticos para P. jiroveci mostró una mayor sensibilidad de la IF y tinción de plata en LBA que en esputo; sin embargo, la RPC fue igualmente sensible en ambos tipos de muestras. Con esta estrategia se logró establecer etiología en la gran mayoría de los pacientes. La etiología más común fue P. jiroveci. IF en LBA sigue siendo el estándar para el diagnóstico de la neumonía por P. jiroveci.

[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.