Clinical Characteristics of the 2019 Eastern Equine Encephalitis Outbreak in Michigan.

Background: Eastern equine encephalitis virus is a mosquito-borne alphavirus responsible for unpredictable outbreaks of severe neurologic disease in animals and humans. While most human infections are asymptomatic or clinically nonspecific, a minority of patients develops encephalitic disease, a devastating illness with a mortality rate of ≥30%. No treatments are known to be effective. Eastern equine encephalitis virus infection is rare in the United States, with an annual average nationwide incidence of 7 cases between 2009 and 2018. However, in 2019, 38 cases were confirmed nationwide, including 10 in Michigan. Methods: Data from 8 cases identified by a regional network of physicians in southwest Michigan were abstracted from clinical records. Clinical imaging and histopathology were aggregated and reviewed. Results: Patients were predominantly older adults (median age, 64 years), and all were male. Results of initial arboviral cerebrospinal fluid serology were frequently negative, and diagnosis was not made until a median of 24.5 days (range, 13-38 days) after presentation, despite prompt lumbar punctures in all patients. Imaging findings were dynamic and heterogeneous, with abnormalities of the thalamus and/or basal ganglia, and prominent pons and midbrain abnormalities were displayed in 1 patient. Six patients died, 1 survived the acute illness with severe neurologic sequelae, and 1 recovered with mild sequelae. A limited postmortem examination revealed diffuse meningoencephalitis, neuronophagia, and focal vascular necrosis. Conclusions: Eastern equine encephalitis is a frequently fatal condition whose diagnosis is often delayed, and for which no effective treatments are known. Improved diagnostics are needed to facilitate patient care and encourage the development of treatments.

Recurrence of Disseminated Mycobacterium avium intracellulare Presenting as Spondylodiscitis and Epidural Abscess in a Patient with Acquired Immune Deficiency Syndrome (AIDS).

BACKGROUND Mycobacterium avium intracellulare complex (MAI) is a member of the non-tuberculous mycobacteria family, which can cause both pulmonary and non-pulmonary disease. In patients with advanced HIV, it is known to cause disseminated disease. We present a case of a 65-year-old man who has sex with men (MSM) with AIDS, found to have spondylodiscitis and an epidural abscess, who had recently completed treatment for disseminated MAI. CASE REPORT The patient was a 65-year-old with AIDS secondary to HIV and a prior history of disseminated MAI, who presented with severe back pain. Upon presentation to the hospital, an MRI was performed, which was suggestive of spondylodiscitis and an epidural abscess. He was taken to surgery for a minimally invasive T12-L1 laminectomy and evacuation of the epidural abscess. Both traditional cultures and acid-fast bacillus (AFB) cultures were negative. Due to worsening pain, he was taken back to surgery for a repeat debridement and biopsy. Repeat cultures were positive for MAI. He was started on rifabutin, ethambutol, azithromycin, and moxifloxacin. Moxifloxacin was subsequently discontinued. He has had problems tolerating the treatment regimen, but is planned to complete an 18-24-month course. CONCLUSIONS For patients with AIDS who have a diagnosis of spondylodiscitis and an epidural abscess, an opportunistic infection such as MAI should be considered. A repeat biopsy should be considered if suspicion is still high, even despite initially negative cultures. Treatment regimens should be prolonged, despite difficulty with medication compliance.

How automatic notification of infectious disease specialists impacted the management of Staphylococcus aureus bacteremia in a community hospital setting.

Objective: The objective of this study was to review the impact of an automatic email notification to infectious disease consultants. Design: Cases were identified from a community hospital system microbiology database by at least one positive blood culture. Records were reviewed both before (2013 and 2014) and after (2015 and 2016) the implementation of the automated email system (intervention). Prior to this policy, consultation with the infectious disease (ID) specialist was at the discretion of the primary team. Results: There were no significant differences in 30-day mortality between the two groups (18 vs 20%, p = 0.10). However, a trend of shorter hospital stays (12.2 vs 9.5 days, p = 0.03) and reduced 30 day readmissions (40% vs 19%, p = 0.03) was observed and antibiotics prescribed for complicated cases was more appropriate (57% vs 85%, p = 0.004). Conclusions: In this study population, the implementation of an automatic email generator to ID specialists was associated with a shorter hospital length of stay, less 30-day readmissions and more appropriate length of antibiotics prescribed in complicated cases of SAB. The authors recommend future studies replicating the methodology employed here with larger sample sizes before consideration of employing a similar automatic email ID consult generation at other health systems.

Probable Locally Acquired Babesia divergens-Like Infection in Woman, Michigan, USA.

We report an asplenic patient who was infected with Babesia divergens-like/MO-1. The clinical course was complicated by multiorgan failure that required intubation and dialysis. The patient recovered after an exchange transfusion and antimicrobial drug therapy. Physicians should be alert for additional cases, particularly in asplenic persons.

The burden of acute respiratory infections in Ecuador 2011-2015.

BACKGROUND: Burden of disease studies intend to improve public health decision-making and to measure social and economic impact in population. The objective of this study was to describe the burden of acute respiratory infections (ARI) in Ecuador between 2011 and 2015. METHODS: Five-year period morbidity and mortality data available from national agencies of statistics was analyzed to estimate the burden of disease attributable to acute respiratory infections. Cases and deaths registered were grouped according to their ICD-10 code into three diagnostic groups: Acute upper respiratory infections (J00-J06), Influenza and pneumonia (J09-J18), and Bronchitis and other acute lower respiratory infections (J20-J22, J85, J86). Disability-adjusted life years stratified by diagnostic and age group were calculated using the "DALY" package for R. The productivity loss in monetary terms was estimated using the human capital method. RESULTS: Over the 5-year period studied there were a total of 14.84 million cases of acute respiratory infections, with 17 757 deaths reported (0.12%). The yearly burden of disease ranged between 98 944 to 118 651 disability-adjusted life years, with an estimated average loss of productivity of US$152.16 million (±19.6) per year. Approximately 99% of the burden can be attributed to years life lost due to premature mortality in population under 5 years old and over 60 years-old. CONCLUSIONS: The burden of acute respiratory infections remained steady during the analyzed period. Evidence-based prevention and control policies to tackle acute respiratory infections in Ecuador should focus on the population at extreme ages of life.

First reported case of Lyme carditis in Southwest Michigan.

Lyme disease is the most common tick-borne infection found in the eastern United States. In recent years, it has become an emergent Michigan public health concern. Lyme carditis is a recognized rare complication which is classically characterized by rapidly fluctuating degrees of heart block. In severe cases, or if inappropriately treated, Lyme carditis can also result in profound bradycardia, perimyocarditis, and sudden cardiac death. This report describes the first documented case of third degree heart block associated with Lyme carditis to occur in Michigan. This is a retrospective case report of a patient evaluated and treated for Lyme carditis in Southwest Michigan in July, 2016. All information was obtained from either the patient or his electronic medical record. Despite initial misdiagnosis and inappropriate management, this patient ultimately received more appropriate medical therapy within 24 hours of first presentation. After eight days of high dose intravenous Ceftriaxone and supportive care, and more than two weeks of oral Doxycycline, the patient's symptoms resolved and the disease was treated to resolution. Neither permanent nor temporary pacing was needed during/after the course of treatment. When correctly identified, Lyme disease and Lyme carditis can be easily treated. Although this patient's history was without reported tick bite or exposure to a known host for Lyme disease, the authors believe that the patient's history and physical exam was definitive enough to warrant the start of IV therapy with telemetry monitoring upon first presentation. The fact that the condition was not first diagnosed by providers indicates a potential gap in medical knowledge and awareness that should be addressed in clinical practice. The authors consider this case a harbinger of the emerging disease of Lyme carditis. Physical exam and EKG findings should guide clinicians' therapeutic approaches. Although treatment with appropriate antibiotics is typically curative, therapeutic delays can lead to deadly results.

Comparison of Acute Kidney Injury During Treatment with Vancomycin and either Piperacillin-Tazobactam or Meropenem.

CONTEXT: Empiric antibiotics are often required in hospitalized patients with serious infections who may be septic and at risk for drug resistant organisms. The purpose of this study was to evaluate the observed incidence of acute kidney injury (AKI) in a sample of adult patients receiving either piperacillin-tazobactam and vancomycin or meropenemvancomycin for at least 72 hours. METHODS: Single-center, retrospective matched cohort at a 200-bed Regional Community Medical Center. Adult patients were included in the sample if they were without preexisting renal dysfunction and admitted over an 18-month time period to receive either the combination of piperacillin-tazobactam and vancomycin or meropenem-vancomycin. Sample patients were evaluated for AKI. This condition was defined by the authors as an increase in serum creatinine of 0.5mg/ml or an increase of 50% above baseline during the duration of antibiotic treatment. RESULTS: A total of 266 patients receiving either combination of antibiotics were evaluated for AKI. The incidence of AKI was significantly higher in the piperacillin-tazobactam and vancomycin group (n = 74/292, 25%) compared with the meropenem-vancomycin group (n=8/74, 9.5%, p=0.008). CONCLUSIONS: The results of this study suggest that the combination of piperacillin-tazobactam and vancomycin is associated with an increased incidence of AKI. Higher vancomycin trough concentrations were associated with increased risk for development of AKI.

First report of orchitis in man caused by Brucella abortus biovar 1 in Ecuador.

We present a 44-year-old man from a rural community in northern Ecuador who worked on a cattle farm where he was involved with primary veterinary care, including assistance during births (or calving) and placenta retention and artificial insemination, with minimal precautions. In September of 2009, quite abruptly, he developed asthenia and hypersomnia without any apparent cause or symptoms like fever, chills, or night sweats. On November 14, 2009, he suffered from pain and edema in the right testicle that coincided with pain in the abdomen. Clinical, serological, and bacteriological investigations confirmed the first case of unilateral orchitis in man in Ecuador caused by Brucella abortus biovar 1. Because brucellosis is a neglected disease, special attention should be given to it in the training of medical and veterinary students.

Emergent 2009 influenza A(H1N1) viruses containing HA D222N mutation associated with severe clinical outcomes in the Americas.

BACKGROUND: During the 2010-2011 influenza season, a small sub-group of 2009 influenza A(H1N1) viruses (hereafter referred to as 2009 A(H1N1)) emerged that was associated with more severe clinical outcomes in Ecuador and North America. Genetically, the haemagglutinin (HA) of this sub-clade was distinct from HAs found in viruses associated with severe outbreaks in 2010 from the United Kingdom and from other global specimens isolated earlier in the season. OBJECTIVE: We report the emergence of a novel 2009 A(H1N1) variant possessing a re-emergent HA D222N mutation obtained from patients with severe respiratory illnesses and phylogenetically characterise these D222N mutants with other severe disease-causing variants clustering within a common emerging sub-clade. CASE REPORTS: In early 2011, three cases of 2009 A(H1N1) infection, two from Quito, Ecuador, and one from Washington, DC, USA, were complicated by severe pneumonia requiring mechanical ventilation, resulting in one fatality. These cases were selected due to the reported nature of the acute respiratory distress (ARD) that were captured in Department of Defence (DoD)-sponsored global influenza surveillance nets. RESULTS: Genetically, the 2009 A(H1N1) strains isolated from two of the three severe cases carried a prominent amino acid change at position 222 (D222N) within the primary HA receptor binding site. Furthermore, these cases represent an emerging sub-clade of viruses defined by amino acid changes within HA: N31D, S162N, A186T and V272I. Phylogenetically, these viruses share a high degree of homology with strains associated with recent fatal cases in Chihuahua, Mexico. DISCUSSION: Previously, enhanced virulence associated with the change, D222G, has been clinically linked to severe morbidity and mortality. Initial observations of the prevalence of a novel sub-clade of strains in the Americas suggest that viruses with a re-emergent D222N mutation may too correlate with severe clinical manifestations. These findings warrant heightened vigilance for emerging sub-clades of 2009 A(H1N1) and presumptive clinical implications.

Hemorragia subaracnoidea no traumática: revisión general y protocolo de manejo en el Hospital Vozandes Quito / Nontraumatic Subarachnoid hemorrhage: overview and management protocol at Hospital Vozandes Quito

La ruptura de un aneurisma intracraneal es la principal causa de una hemorragia subaracnoidea (HSA) no traumática. Los pacientes usualmente se presentan con una combinación de síntomas, de los cuales la cefalea súbita y severa suele ser la principal manifestación. El tratamiento temprano del aneurisma es fundamental para reducir el riesgo de resangrado. La oclusión endovascular del aneurisma con "coils" ha demostrado que se asocia con mejores resultados a corto y largo plazo. Sin embargo, la vigilancia angiográfca es necesaria después del tratamiento endovascular y en ocasiones puede requerirse una embolización adicional. Una vez que el aneurisma ha sido tratado, el vasoespasmo cerebral tardío es la principal causa de daño cerebral y puede requerirse una angioplastia del vaso afectado o la infusión intraarterial de vasodilatadores. Por estas razones, los diferentes problemas del paciente deben ser abordados por un equipo médico multidisciplinario.

The rupture of an intracranial aneurysm is the main cause of bleeding nontraumatic subarachnoid (HSA). Patients usually present with a combination of symptoms, of which sudden and severe headache is usually The main manifestation. Early treatment of aneurysm is essential to reduce the risk of bleeding. Endovascular aneurysm occlusion with "coils" has been shown to be associated with better short and long results term. However, angiographic monitoring is necessary after endovascular treatment and sometimes additional embolization may be required. Once the aneurysm has been treated, late cerebral vasospasm it is the leading cause of brain damage and an angioplasty of the affected vessel or intraarterial infusion of vasodilators. For these reasons, the Different patient problems should be addressed by a medical team multi-disciplinary.

Sentinel surveillance of influenza-like-illness in two cities of the tropical country of Ecuador: 2006-2010.

BACKGROUND: Tropical countries are thought to play an important role in the global behavior of respiratory infections such as influenza. The tropical country of Ecuador has almost no documentation of the causes of acute respiratory infections. The objectives of this study were to identify the viral agents associated with influenza like illness (ILI) in Ecuador, describe what strains of influenza were circulating in the region along with their epidemiologic characteristics, and perform molecular characterization of those strains. METHODOLOGY/FINDINGS: This is a prospective surveillance study of the causes of ILI based on viral culture of oropharyngeal specimens and case report forms obtained in hospitals from two cities of Ecuador over 4 years. Out of 1,702 cases of ILI, nine viral agents were detected in 597 patients. During the time of the study, seven genetic variants of influenza circulated in Ecuador, causing six periods of increased activity. There appeared to be more heterogeneity in the cause of ILI in the tropical city of Guayaquil when compared with the Andean city of Quito. CONCLUSIONS/SIGNIFICANCE: This was the most extensive documentation of the viral causes of ILI in Ecuador to date. Influenza was a common cause of ILI in Ecuador, causing more than one outbreak per year. There was no well defined influenza season although there were periods of time when no influenza was detected alternating with epidemics of different variant strains.

A case of yellow fever vaccine-associated viscerotropic disease in Ecuador.

We report the first case of viscerotropic syndrome in Ecuador. Because of similarities between yellow fever and viscerotropic syndrome, the incidence of this recently described complication of vaccination with the 17D yellow fever vaccine is not known. There is a large population in South America that is considered at risk for possible reemergence of urban yellow fever. Knowledge of potentially fatal complications of yellow fever vaccine should temper decisions to vaccinate populations where the disease is not endemic.

Antiviral resistance in influenza viruses circulating in Central and South America based on the detection of established genetic markers.

BACKGROUND: Recent influenza antiviral resistance studies reveal an alarming increase in both adamantanes and neuraminidase inhibitors (NAIs) resistant viral strains worldwide, particularly in Asia, Europe and the United States. OBJECTIVES: In this study, we have evaluated influenza virus resistance in Central and South America. METHODS: Influenza viruses, isolated from symptomatic patients throughout Central and South America in 2005-2008 were analyzed for inhibitor resistance. The M2 and NA genes of influenza viruses were sequenced and resistance was inferred by comparison with published sequences and known resistant mutations. RESULTS: Our results indicate that: (i) resistance to adamantanes was seen in the majority (95.5%) of the influenza A/H3N2 isolates but only in one isolate of the influenza A/H1N1 viruses; (ii) resistance to NAIs began to be detected in A/H1N1 isolates from Central America in 2008; and (iii) none of the influenza B viruses analyzed were resistant to NAIs. CONCLUSIONS: These findings suggest a limited effectiveness of influenza inhibitors due to the detection of resistance among A/H1 and A/H3 viruses.

Avances en el diagnóstico de tuberculosis pulmonar / Advances in the diagnosis of tuberculosis pulmonary

Para poder salvar la vida del paciente y parar la transmisión de Mycobacterium tuberculosis (Mtb) a otros pacientes y a los trabajadores de salud es importante diagnosticar tuberculosis pulmonar de la manera más rápida posible. Por la epidemia global del virus de inmunodeficiencia humana (VIH), la disponibilidad de nuevos tratamientos de inmunosupresión para enfermedades como artritis reumatoide, y la emergencia de cepas de tuberculosis resistentes a los antifímicos, un diagnóstico rápido es más importante que nunca. Ha surgido una plétora de pruebas rápidas, cada una está amparada con estudios que sugieren que tal prueba puede ser útil en el diagnóstico precoz de la enfermedad de tuberculosis. La eficacia de una nueva prueba rápida en diagnosticar Mtb en pacientes con inmunodepresión es el campo donde podemos determinar la capacidad diagnóstica.

In order to save the patient's life and stop the transmission of Mycobacterium tuberculosis (Mtb) to other patients and to health workers it is important to diagnose tuberculosis lung as quickly as possible. For the epidemic global human immunodeficiency virus (HIV), the availability of new immunosuppression treatments for diseases such as rheumatoid arthritis, and the emergency of antifungal resistant strains of tuberculosis, a Quick diagnosis is more important than ever. A plethora of rapid tests has emerged, each one is covered by studies that suggest that such a test may be useful in the early diagnosis of tuberculosis disease. The efficacy of a new rapid test in diagnosing Mtb in patients with immunosuppression is the field where we can Determine the diagnostic capacity.

Investigation of an outbreak of central venous catheter-associated bloodstream infection due to contaminated water.

An outbreak of central venous catheter-associated bloodstream infections was reported in a hospital in Ecuador. Commercially produced ampoules of water for injection were found to be contaminated with Burkholderia cepacia and Myroides odoratus. Removal of these ampoules yielded a 10-fold reduction in the incidence of catheter-associated infection.

Wound botulism acquired in the Amazonian rain forest of Ecuador.

Wound botulism results from colonization of a contaminated wound by Clostridium botulinum and the anaerobic in situ production of a potent neurotoxin. Between 1943, when wound botulism was first recognized, and 1990, 47 laboratory-confirmed cases, mostly trauma-associated, were reported in the United States. Since 1990, wound botulism associated with injection drug use emerged as the leading cause of wound botulism in the United States; 210 of 217 cases reported to the Centers for Disease Control and Prevention between 1990 and 2002 were associated with drug injection. Despite the worldwide distribution of Clostridium botulinum spores, wound botulism has been reported only twice outside the United States, Europe, and Australia. However, wound botulism may go undiagnosed and untreated in many countries. We report two cases, both with type A toxin, from the Ecuadorian rain forest. Prompt clinical recognition, supportive care, and administration of trivalent equine botulinum antitoxin were life-saving.

Septicemia por salmonella no tiphy / Salmonella non tiphy septicemia

Se trata de un paciente con tos de 5 meses de evolución, fiebre de 3 meses, que ha visto otros servicios de salud para solucionar su problema. Con investigaciones negativas para tuberculosis, un cultivo de esputo con klebsiella Pneumoniae por lo que recibió ciprofloxacina durante 5 días. Viene al hospital Vozandes Quito, aún con fiebre, malestar genera y odinofagia. En el examen físico un eritema leve en orofaringe y un ganglio cervical, el resto normal. Es hospitalizado como fiebre de origen desconocido y se inicia investigaciones básicas que inicialmente destacan alteración en reactantes de fase aguda y hepatopatía. Con exámenes más invasivos se dermina por un mielocultivo la presencia de salmonella cholerasuis. Luego de 4 días de 2 gramos diarios de ceftriaxona intravenosa cede la fiebre. A los 7 días de antibióticoterapia sistémica, sale con el alta y toma ciprofloxacina 750 mg dos veces al día por 10 días más. Presentamos dos revisiones bibliográficas sobre fiebre de origen a determinar y salmonellosis por choleraesuis. En el Ecuador se han reportado pocos casos de infección por salmonella cholerasuis, en un estudio realizado en 1989 y 1993 entre todas las especies de salmonelas el 36% eran de serotipo Cholerasuis, Se ha aislado de tejidos de pollo, a diferencia de Asia donde es frecuente que habite en cerdos. Se transmite a través agua y alimentos contaminados. Se caracteriza por dos tipos de presentación clínica: Síndrome e bacteriemia sostenida con fiebre e infecciones focales extraintestinales. Todavía no hemos encontrado resistencia antibiótica, como se ha reportado en otros países.

This is a patient with a cough of 5 months of evolution, fever of 3 months, who has seen other health services to solve his problem. With negative investigations for tuberculosis, a sputum culture with klebsiella Pneumoniae so he received ciprofloxacin for 5 days. He comes to the Vozandes Quito hospital, even with fever, general discomfort and odynophagia. On physical examination, a slight erythema in the oropharynx and a cervical ganglion, the rest normal. He is hospitalized as a fever of unknown origin and basic investigations are started that initially highlight alteration in acute phase reactants and liver disease. With more invasive examinations, the presence of salmonella cholerasuis is revealed by a myeloculture. After 4 days of 2 grams daily of intravenous ceftriaxone fever subsides. After 7 days of systemic antibiotic therapy, she is discharged and takes ciprofloxacin 750 mg twice a day for 10 more days. We present two bibliographic reviews on fever of origin to be determined and choleraesuis salmonellosis. In Ecuador, few cases of salmonella cholerasuis infection have been reported. In a study carried out in 1989 and 1993, 36% of all salmonella species were of the Cholerasuis serotype. They have been isolated from chicken tissues, unlike Asia, where it is frequently inhabits pigs. It is transmitted through contaminated food and water. It is characterized by two types of clinical presentation: syndrome and sustained bacteremia with fever and focal extra-intestinal infections. We have not yet found antibiotic resistance, as has been reported in other countries.

Aislamiento de la bacteria CDC grupo Nº-1, un "Nuevo" Bacilo Gram negativo asociado con la mordedura de perro / Isolation of the CDC group Nº-1 bacteria, a "New" Gram negative Bacillus associated with dog bite

La bacteria CDC grupo NO-1 es una bacteria asociada a las mordeduras de perros y gatos en individuos sanos. De 1974 a 1998, 22 aislamientos han sido identificados en Estados Unidos por el laboratorio de referencia " Centros para el control y prevención de las enfermedades" conocidos como CDC. La bacteria tiene características similares a Acinectobacter, pero se diferencia por su morfología celular y su superficie de ácidos grasos. Reportamos el caso de un paciente de 16 años de edad que fue mordido por un perro en el miembro inferior izquierdo, desarrollo una celulitis y en el cultivo de la secreción purulenta se identifico la bacteria NO-1, mediante el sistema Remel, ERIC! ( Electronic RapID NF plus) para no fermentadores (RapID NF plus) con el código 000002. El paciente recibió un esquema terapéutico de ampicilina/sulbactam y evolucionó favorablemente. El reporte de este aislamiento es importante debido a que la incidencia de esta bacteria es prácticamente desconocida y está considerada como una zoonosis emergente. Referirla pondrá en alerta a los médicos y a los laboratorios que podrían no reconocerla y pasarla por alto.

The CDC group NO-1 bacterium is a bacterium associated with dog and cat bites in healthy individuals. From 1974 to 1998, 22 isolates have been identified in the United States by the reference laboratory "Centers for Disease Control and Prevention" known as CDC. The bacterium has characteristics similar to Acinectobacter, but it is differentiated by its cellular morphology and its fatty acid surface. We report the case of a 16-year-old patient who was bitten by a dog in the lower left limb, developed cellulite and the NO-1 bacteria was identified in the culture of the purulent secretion, using the Remel system, ERIC! (Electronic RapID NF plus) for non-fermenters (RapID NF plus) with the code 000002. The patient received an ampicillin / sulbactam treatment regimen and did well. The report of this isolation is important because the incidence of this bacterium is practically unknown and is considered an emerging zoonosis. Referring her will alert doctors and laboratories that may not recognize her and overlook her.

Grand round botulismo por herida penetrante: presentación de un caso clínico y revisión de la bibliografía / Grand round botulism by penetrating wound: presentation of a clinical case and revision of the bibliography

El botulismo es una rara enfermedad neuroparalítica causada por la toxina de clostridium botulinum. Presentamos el caso de un paciente procedente de la amazonía ecuatoriana, que acudió por presentar un cuadro clínico sugestivo de botulismo por herida y en quien se pudo hacer confirmación diagnóstica de laboratorio. Este es probablemente, el primer caso registrado en Ecuador y América del Sur. Al final se muestra una revisión bibliográfica del tema.

Histoplasmosis infección oportunista común en el Ecuador / Histoplasmosis opportunistic infection common in Ecuador

Debido a las referencias geográficas en la endemnicidad de infecciones, cada país necesita establecer su propio perfil de infecciones oportunistas en el manejo de SIDA. Histoplasmosis es una infección que suele confundirse con tuberculosis. En este artículo se presenta 6 pacientes HIV positivos con histoplasmosis diseminada. La mayoría de los pacientes presentaron pancitopenia, hepatitis infiltrada difusa reticulonodular. El método de diagnóstico más rápido y confiable era la biopsia de la médula ósea. Dentro de 6 meses 5 de los 6 pacientes murieron con histoplasmosis diseminada.