Brote de Shigella sonnei en un centro escolar de Gipuzkoa / Shigella sonnei outbreak in a school in Northern Spain

En octubre de 2012 se detectó un brote de gastroenteritis aguda por Shigella sonnei en una escuela del norte de España que afectó a 112 personas: el 63,7% fueron escolares y docentes y el 35,7% convivientes. El origen fue un niño enfermo con antecedente de viaje a país endémico, y el desencadenante, las deficiencias higiénicas existentes en uno de los aseos de la escuela. La aplicación de estrictas medidas de higiene fueron determinantes para el control del brote

In October 2012, an outbreak of acute gastroenteritis caused by Shigella sonnei was detected in a nursery and primary school in the north of Spain affecting 112 people: 63.7% were pupils and teachers and 35.7% their co-habitants. The source was a sick child who had travelled to an endemic country, and the key trigger factor was inadequate hygiene in one of the toilets of the school. The enforcement of strict hygiene measures was essential for controlling the outbreak

[Shigella sonnei outbreak in a school in Northern Spain]. / Brote de Shigella sonnei en un centro escolar de Gipuzkoa.

In October 2012, an outbreak of acute gastroenteritis caused by Shigella sonnei was detected in a nursery and primary school in the north of Spain affecting 112 people: 63.7% were pupils and teachers and 35.7% their co-habitants. The source was a sick child who had travelled to an endemic country, and the key trigger factor was inadequate hygiene in one of the toilets of the school. The enforcement of strict hygiene measures was essential for controlling the outbreak.

Prognosis of cryptogenic ischemic stroke: a prospective single-center study in Chile.

Approximately 25%-40% of ischemic strokes are considered of unknown cause (ie, cryptogenic). The available information on associated risk factors, functional outcome, and recurrence of this subtype of stroke is limited, especially for the Chilean population. We conducted a prospective cohort study of 380 patients aged ≥ 18 years admitted consecutively to a stroke unit with demonstrated ischemic stroke. The stroke subtypes were classified according to the Trial of Org 10172 in Acute Stroke Treatment criteria. The modified Rankin Scale score and Barthel Index were used to assess functional outcome. The Kaplan-Meier product-limit method and Cox proportional hazards regression analysis were used to identify predictors of recurrent stroke during the follow-up period (mean, 2.1 years). Cryptogenic stroke (CS) was diagnosed in 76 patients (20%), 55.2% of them male, with a mean age of 62 ± 17 years. CS was the third most common stroke subtype after the large-artery disease (29%) and cardioembolic (24.4%) subtypes. After adjustment for age and sex, no vascular risk factors or laboratory parameters assessed at the time of admission were found to be predictive of CS. The CS subtype had the lowest rate of stroke recurrence at the end of the follow-up period (n = 4; 2.5% per year; odds ratio, 0.32; 95% confidence interval, 0.11-0.91; P = .022), a favorable functional outcome (mean modified Rankin Scale score, 2; mean Barthel Index, 77), and no increase in mortality risk (odds ratio, 0.73; 95% confidence interval, 0.29-1.77; P = .48). Our findings demonstrate that patients with no definite etiology identified after an extensive workup are at lower risk of recurrence and more likely to have a favorable outcome. No risk factors distinguish CS from other stroke subtypes in our study population.

Prospective, observational, cross-sectional study of intestinal infections among acutely active inflammatory bowel disease patients.

BACKGROUND: Intestinal infections have been claimed to precipitate or aggravate flares of inflammatory bowel disease (IBD). The reported incidence of such infections among IBD patients varies between 9 and 13%, but only a few prospective studies have been conducted. AIMS: To evaluate the incidence of intestinal infections by enteropathogens in patients with active IBD, their impact on clinical outcome, and to identify associated risk factors. PATIENTS AND METHODS: Consecutive patients admitted because of a relapse or suspected onset of IBD were prospectively included. At admittance, stool samples for culture, examination for intestinal parasites, and cytotoxin assay for Clostridium difficile were collected. Baseline clinical characteristics, potential risk factors for gastrointestinal infections, and clinical outcome were recorded. RESULTS: Ninety-nine episodes were included. Six intestinal infections were diagnosed in 6 patients (5 ulcerative colitis, 1 ileocolonic Crohn's disease), Campylobacter jejuni being the most frequent isolated microbe (n = 5). None of the patients with intestinal infection needed surgery, but two of them required second-line therapies. CONCLUSIONS: Gastrointestinal infections among IBD patients do not exceed 10% and occur mostly in patients with extensive involvement of the colon. Infection by enteropathogenic bacteria does not appear to be associated with a poorer clinical outcome of the IBD flare.

[Thrombolysis for stroke in a 93-year-old female: report of a case]. / Trombolisis cerebral en el adulto mayor: Caso clínico.

Most studies evaluating the usefulness of intravenous thrombolysis for acute stroke have excluded subjects aged over 80 years. Therefore there is no evidence to support or contraindícate this therapy in this age group. We report a 93 year-old female subjected to intravenous thrombolysis using tissue plasminogen activator (r-tPA), according to the National Institute of Neurological Disorders protocol. The treatment was successful, there were no hemorrhagic complications and three months later, the patient was practically without any disability. Therefore age is not an absolute contraindication for intravenous thrombolysis in elderly subjects.

Trombolisis cerebral en el adulto mayor: Caso clínico / Thrombolysis for stroke in 93 years old female: Report of one case

Most studies evaluating the usefulness of intravenous thrombolysis for acute stroke have excluded subjects aged over 80 years. Therefore there is no evidence to support or contraindícate this therapy in this age group. We report a 93 year-old female subjected to intravenous thrombolysis using tissue plasminogen activator (r-tPA), according to the National Institute of Neurological Disorders protocol. The treatment was successful, there were no hemorrhagic complications and three months later, the patient was practically without any disability. Therefore age is not an absolute contraindication for intravenous thrombolysis in elderly subjects.

Comparison of the sodium hydroxide specimen processing method with the C18-carboxypropylbetaine specimen processing method using independent specimens with auramine smear, the MB/BacT liquid culture system, and the COBAS AMPLICOR MTB test.

A study was performed to diagnose tuberculosis by smear, culture, and nucleic acid amplification. The study was comprised of two independent arms. Each arm used a different specimen processing method; in one arm, all specimens were processed with N-acetyl-l-cysteine-sodium hydroxide, and in the other arm, all specimens were processed with C(18)-carboxypropylbetaine and lytic enzymes. In each arm, all processed sediments were split for analysis by auramine smear, by culture using the MB/BacT liquid culture system and solid media, and by nucleic acid amplification using the COBAS AMPLICOR MTB test. In the N-acetyl-l-cysteine-sodium hydroxide arm, 1,468 specimens were analyzed: 65 were smear positive; 88 and 42 were culture positive for Mycobacterium tuberculosis and nontuberculous mycobacteria, respectively; and 103 were PCR positive. Relative to cultures positive for M. tuberculosis, the sensitivity and specificity of the smear were 68.2% and 99.6%, respectively, and those of PCR were 75.0% and 97.3%, respectively. In the C(18)-carboxypropylbetaine study arm, 1,423 specimens were analyzed: 44 were smear positive; 82 and 31 were culture positive for M. tuberculosis and nontuberculous mycobacteria, respectively; and 91 were PCR positive. The sensitivity and specificity of the smear were 48.8% and 99.7%, respectively, and those of PCR were 78.0% and 98.0%, respectively. When the two arms were compared, C(18)-carboxypropylbetaine specimen processing significantly increased the number of smear-negative and culture-positive specimens and significantly increased the PCR sensitivity among this same group of specimens while at the same time significantly reducing the inhibition rate.

Molecular analysis of isoniazid and rifampin resistance in Mycobacterium tuberculosis isolates recovered from Barcelona.

We studied the presence of mutations in the whole katG gene and specific regions of the oxyR-ahpC and mabA-inhA regulatory region in 61 Mycobacterium tuberculosis isoniazid-resistant isolates. An 81-bp region of the rpoB gene was also sequenced in 17 rifampin-resistant strains. Alterations in the katG gene were detected in 55% of the isolates. Mutation in codon 315 was the most prevalent (32%). Strains showed a high level of resistance, and most maintained a substantial catalase-peroxidase activity. Three strains with an isoniazid MIC of >or=32 microg/ml lacked catalase-peroxidase activity. Two of them had deletions in the catalytic domain of the KatG protein. One strain with deletion and three strains with mutations in the C-terminal domain showed low-level resistance and conserved the catalase-peroxidase activity. Mutations in the mabA-inhA regulatory region were identified in 32% of the isolates. All had low-level resistance, and the vast majority conserved catalase-peroxidase activity. Seventeen percent of the isoniazid-resistant isolates had no detectable alterations at the studied loci. Resistance to rifampin was associated with mutations in the 81-bp of the rpoB gene in all cases. IS6110 analysis indicated that recent transmission contributed substantially to the emergence of isoniazid- resistant tuberculosis in Barcelona through short transmission chains. A rapid genotypic assay, including the 315-katG codon and the -15 nucleotide of the mabA-inhA regulatory region, may cover 62% of isoniazid- resistant strains in Barcelona. In contrast, the targeting of the 81-bp region of rpoB would detect all our rifampin-resistant isolates.

Comparative evaluation of the new version of the INNO-LiPA Mycobacteria and genotype Mycobacterium assays for identification of Mycobacterium species from MB/BacT liquid cultures artificially inoculated with Mycobacterial strains.

The performance of two DNA line probe assays, a new version of INNO-LiPA Mycobacteria (Innogenetics, Ghent, Belgium) and the GenoType Mycobacterium (Hain Diagnostika, Nehren, Germany), were evaluated for identification of mycobacterial species isolated from liquid cultures. Both tests are based on a PCR technique and designed for simultaneous identification of different mycobacterial species by reverse hybridization and line probe technology. The INNO-LiPA Mycobacteria v2 targeting the 16S-23S rRNA gene spacer region was developed for the simultaneous identification of 16 different mycobacterial species. The GenoType Mycobacterium, which targets the 23S rRNA gene, allows simultaneous identification of 13 mycobacterial species. Both tests were evaluated on 110 mycobacterial strains belonging to 22 different mycobacterial species (20 reference strains, 83 clinical strains, and 4 Mycobacterium kansasii strains isolated from tap water) that were previously inoculated into MB/BacT bottles. The sensitivity of both methods, defined as the number of positive results obtained with the Mycobacterium genus probe together with an interpretable result on the number of samples tested was 110 of 110 (100%) for INNO-LiPA and 102 of 110 (92.7%) for GenoType. For samples with interpretable results, INNO-LiPA was able to correctly identify 109 of 110 samples (99.1%), whereas the GenoType correctly identified 100 of 102 samples (98.0%). Both tests were easy to perform, rapid, and reliable when applied to mycobacterial identification directly from MB/BacT bottles.

Farmacorresistencia de mycobacterium tuberculosis. Estudio multicéntrico en el área de Barcelona / Drug resistance of Mycobacterium tuberculosis. Multicenter study in Barcelona, Spain

Fundamento: El objetivo fue conocer, mediante un estudio multicéntrico y con la colaboración de clínicos, microbiólogos y epidemiólogos, el nivel de resistencias de Mycobacterium tuberculosis en el área de Barcelona y su relación con datos clínicos de los pacientes para establecer posibles grupos de riesgo. Pacientes y método: Se incluyeron las cepas de M. tuberculosis aisladas de los pacientes diagnosticados bacteriológicamente desde octubre de 1995 a septiembre de 1997, revisándose su historial clínico. Se estudió la resistencia a isoniacida, rifampicina, estreptomicina, etambutol y pirazinamida mediante el sistema Bactec 460. Los factores asociados a resistencia se analizaron mediante regresión logística. Resultados: El total de pacientes fue de 1.749 (1.535 iniciales y 214 tratados anteriormente). La resistencia primaria fue 5,7 por ciento (isoniacida, 3,8 por ciento; rifampicina, 1,0 por ciento, estreptomicina, 2,1 por ciento, etambutol, 0,3 por ciento y pirazinamida, 1,0 por ciento). La resistencia adquirida alcanzó el 20,5 por ciento (isoniacidas, 17,3 por ciento, rifampicina, 9,8 por ciento, etambutol, 1,9 por ciento, estreptomicina, 4,7 por ciento y pirazinamida, 6,5 por ciento). La multirresistencia primaria fue 0,9 por ciento, y la adquirida 9,3 por ciento. Las resistencias primarias totales, a isoniacida y a pirazinamida se asociaron con inmigración y se objetivaron algunas diferencias entre laboratorios atribuibles a diferencias de población. Las resistencias adquiridas totales y a isoniacida se asociaron a más de 60 años y al sexo femenino. Conclusiones: El bajo nivel de resistencias primarias a isoniacida permite tratar los casos iniciales con 3 fármacos, salvo en determinados grupos de inmigrantes. Se recomienda realizar pruebas de sensibilidad en todas las cepas aisladas y realizar estudios de farmacorresistencia en tuberculosis basados en trabajos coordinados para evitar sesgos de población. (AU)

Evaluación de la efectividad de las normas terapéuticas propuestas en el Hospital Clínico Universidad de Chile, para neumonía e infección urinaria / Evaluation of efectivity of therapeutic standards proposed at Universidad de Chile clinical hospital, for pneumonia and urinary infections

Introducción: dado el creciente interés que existe en desarrollar y aplicar guías clínicas en las instituciones de salud, con el objeto de asegurar una calidad homogénea de atención y ayudar a manejar los costos de la atención médica, se decidió evaluar la efectividad de los esquemas terapéuticos sugeridos en las normas terapéuticas elaboradas recientemente en el Hospital Clínico de la Universidad de Chile con el objeto de determinar que los esquemas sugeridos son, al menos, tan efectivos como otros esquemas usados en nuestra institución. Objetivo: evaluar la efectividad de los esquemas terapéuticos sugeridos en las normas terapéuticas del Hospital Clínico de la Universidad de Chile para neumonía e infección urinaria, en términos de: días de hospitalización, días de fiebre, complicaciones y letalidad. Metodología: se usó un diseño observacional prospectivo, en que la decisión de usar los esquemas sugeridos en las normas fue de los médicos tratantes en el momento del ingreso de los pacientes, con lo que se conformaron dos grupos, los que fueron seguidos por los investigadores desde el momento del ingreso al hospital hasta su alta, consignándose los parámetros más arriba referidos para la evaluación de la efectividad más edad, sexo y diagnóstico. Ambos grupos fueron posteriormente comparados, para establecer si existián diferencias en relación a los parámetros usados. Resultados: no se encontraron diferencias estadísticamente significativas en realación a edad, sexo ni tipo de diagnóstco en los grupos estudiados. En relación a los parámetros usados para medir efectividad los resultados en el grupo que cumplió con las normas terapéuticas fueron (promedio ñ desviación estánder): días de hospitalización: 111 ñ 6,2 días, días de fiebre: 5,2 ñ 5,1 días, complicaciones: 2,04 por ciento, letalidad: 0 por ciento; y en el grupo que no cumplió con las normas terapéuticas: días de hospitalización: 12,2 ñ 8,6 días con fiebre: 3,8 ñ 6,4, complicaciones 10,2 por ciento, letalidad: 2,04 por ciento. Estas diferencias no fueron estadísticamente significativas. Si los mismos parámetros se analizan de acuerdo a categorías diagnósticas (neumonía e infección urinaria), tampoco se encontraron diferencias estadísticamente significativas, aunque en los pacientes con infección urinaria que no cumplieron con las normas, se encontró un número menor de días con fiebre y esta diferencia estuvo en los límites de la significación estadística

Videotoracoscopía en el diagnóstico de lesiones pulmonares / Videothorascopic procedures in the pulmonary injuries diagnosis

Se analizaron los casos de pacientes con diagnóstico de nódulo pulmonar sometidos a videotoracoscopía (VTC) en el Hospital Clínico de la Universidad de Chile, entre 1991 y 1998. Durante este período se efectuaron 35 VTC. La edad promedio de los pacientes fue de 54.3 años. La estadía hospitalaria fue en promedio de 4.5 días y el tiempo operatorio fue de 20 minutos en promedio, excepto en aquellos casos en que se realizaron resecciones mayores. El estudio de anatomía patológica confirmó el diagnóstico de 7 cánceres pulmonares primarios, 14 de origen metastásico de diferente origen, 12 lesiones benignas y 2 mesoteliomas. Fue necesario convertir a toracotomía abierta en 6 casos (17.1 por ciento) para realizar resecciones pulmonares mayores. Se observó que 10 pacientes tenían antecedentes previos de cánceres primarios que hacían sospechar el diagnóstico encontrado, pero en 4 casos el diagnóstico se efectuó exclusivamente gracias a esta técnica. Las indicaciones de VTC, por su corto tiempo de uso, están en plena evolución, sin embargo, tiene muchas ventajas. Por ser una cirugía mínimamente invasiva, tiene una estadía hospitaaria corta, menor dolor durante el postoperatorio, baja mortalidad y alto rendimiento diagnóstico, pudiendo mejorar, en casos seleccionados, significativamente el estudio de lesiones pulmonares