[Respiratory infections and bacteremia caused by Neisseria meningitidis serogroup W]. / Infecciones respiratorias bacteriémicas por Neisseria meningitidis serogrupo W.

N. meningitidis serogroup W has recently been introduced into Chile. This serogroup has been associated with hypervirulent strains capable of causing outbreaks. Furthermore, there is data suggesting that the spectrum of clinical manifestations varies among different serogroups. Here we describe three cases of community acquired respiratory infections caused by N. meningitidis W, which were diagnosed by blood culture during 2013 in our hospital.

Hepatitis B and C virus infection among HIV patients within the public and private healthcare systems in Chile: A cross-sectional serosurvey.

BACKGROUND: Coinfections of HIV patients with hepatitis B virus (HBV) and hepatitis C virus (HCV) are mayor public health problems, contributing to the emerging burden of HIV-associated hepatic mortality. Coinfection rates vary geographically, depending on various factors such as predominant transmission modes, HBV vaccination rates, and prevalence of HBV and HCV in the general population. In South America, the epidemiology of coinfections is uncertain, since systematic studies are scarce. Our study aimed to analyze rates of HBV and HCV infection in people living with HIV attending centers of the public and private health system in Chile. METHODS: We performed a cross-sectional study including a public university hospital and a private health center in Santiago, Metropolitan Region in Chile. Serum samples were used to determine serological markers of hepatitis B (HBsAg, anti-HBs, anti-HBc total, HBeAg, anti-HBe) and anti-HCV. Demographic, clinical and laboratory data were obtained from medical records. RESULTS: 399 patients were included (353 from public, 46 from private health center). Most (92.8%) were male, with a median age of 38.3 years; 99.4% acquired HIV through sexual contact (75.0% MSM); 25.7% had AIDS and 90.4% were on ART. In 78.9%, viral loads were <40 cps/mL; the median CD4 cell count was 468 cells/mm3. According to their serological status, 37.6% of patients were HBV naïve (susceptible), 6.5% were vaccinated, 43.6% had resolved HBV infection, and 5.8% were chronically infected. The rate of vaccination was 4.5% in the public and 21.7% in the private system. HCV coinfection was found in 1.0% of all patients. CONCLUSION: HBV coinfection rate was within the range of other South American countries, but lower than in non-industrialized regions in Asia and Africa. A low percentage of patients were HBV vaccinated, especially within the public system. HCV coinfection rate was very low, most probably due to the rareness of injecting drug use.

Formación de especialistas en Latinoamérica. Rol de las universidades chilenas / Training of specialists in Latin America: role of Chilean universities

Chile tiene una tasa de médicos de 1,7/1.000 habitantes, menor al promedio de los países de la OCDE (3,2/1.000). Considerando el número de facultades de medicina (22) y de egresados por año (se proyectan para el quinquenio 2015-2020 10.883 nuevos médicos), esta falencia se podrá solucionar en un plazo razonable. Hay en el país facultades de medicina públicas y privadas, con un sistema único de admisión en el que se considera el rendimiento de la etapa escolar, pruebas específicas de selección universitaria y ajustes de acuerdo con el origen del estudiante, con el objeto de mejorar la equidad en el acceso. La acreditación de la carrera de Medicina es obligatoria para todas las universidades y los criterios de titulación son dependientes de cada centro. Hay un examen de habilitación que mide competencias teóricas para los egresados de universidades chilenas y además uno práctico para quienes estudian en el extranjero. El Ministerio de Salud de Chile ha estimado que existe en el país un déficit de especialistas, además de un problema de distribución geográfica de los mismos. Para superar progresivamente esta situación, el Estado ha desarrollado un plan expansivo de programas de especialización, bajo un estricto sistema de acreditación de calidad, tomando en cuenta que los programas de especialización en Chile son universitarios. El Estado financia la mayor parte de los programas de formación de especialistas, exigiendo a los graduados un tiempo de trabajo en la red pública de salud al finalizar sus programas. Cada centro universitario puede a su vez financiar programas propios con períodos de devolución en la misma institución. La acreditación y reacreditación de especialistas dependen de estructuras reguladas por el Estado

Chile has a physician rate of 1.7/1,000 inhabitants, lower than the average of the OECD countries (3.2/1,000). The country currently has 22 medical schools and more than 10,000 new doctors are expected by 2020. There are public and private medical schools in the country, with a unique system of admission that considers the qualifications of secondary education, specific tests of university selection and adjustments according to the origin of the students, in order to improve equity in access. Accreditation of a medical degree is a requirement for all universities. At the end of the course, there is an habilitation exam that measures theoretical competences for graduates of Chilean universities and also a practical one for those studying abroad. The Ministry of Health of Chile has estimated that there is a shortage of specialists in the country, as well as a problem of geographical distribution. To progressively overcome this situation, the state has developed an expansive plan of specialization programs, under a strict system of quality accreditation, taking into account that the specialization programs in Chile are all dependent on universities. The state supports most specialist training programs, requiring graduates to work in the public health network at the end of their programs. Each university can finance its own programs with repayment periods in the same institution. The accreditation of specialists depends on structures regulated by the state

Breakthrough bacteremia due to Clostridium tertium in a patient with neutropenic fever, and identification by MALDI-TOF mass spectrometry.

Clostridium tertium is rare in a human clinical specimen and its pathogenicity is often uncertain. However, the organism has been increasingly recognized as a cause of bacteremia and other infections in immunocompromised patients, especially those with hematologic malignancies. The diagnosis and treatment of C. tertium are difficult due to its growth pattern, micromorphology, and antibiotic resistance. The organism can easily be misidentified as Gram-positive aerobic rods such as Bacillus species, usually considered as a contaminant. Furthermore, it is not covered by empirical treatment with many broad-spectrum antibiotics. Here we report a case of breakthrough bacteremia due to C. tertium that occurred in a patient with acute leukemia and neutropenic fever, who was treated with an empirical regimen of ceftazidime and amikacin. The bacterium was rapidly identified by new mass spectrometry technology (MALDI-TOF MS) and the patient recovered under meropenem and vancomycin treatment, without complications.

Pandemic influenza A (H1N1) 2009 with neurological manifestations, a case series.

OBJECTIVES: Describe a series of atypical presentations of pandemic influenza A (H1N1) 2009. METHODS: Description of case series using hospital records. RESULTS: Six patients aged 1 to 65 years with confirmed pandemic influenza A (H1N1) 2009 infection presented with neurological complications within 2 to 5 days after the first signs of influenza-like illness. All six were admitted with seizures or altered mental status. No abnormalities were found in brain scans or cerebral spinal fluid studies of any of the six. All were discharged without sequelae within days of admission. CONCLUSIONS: This is only the second report of pandemic influenza presenting with neurological manifestations. Clinicians caring for patients when pandemic influenza is prevalent in their communities should maintain a high level of awareness of the potential atypical presentations with which this disease can appear.

[Community acquired infections with methicillin resistant strains of Staphylococcus aureus: report of five cases]. / Staphylococcus aureus comunitario resistente a cloxacilina: Comunicación de los primeros cinco casos descritos en Chile.

Community acquired infections with methicillin resistant strains of Staphylococcus aureus (MRSA) infections have a more aggressive clinical course and involve mostly skin and lungs. These infections appear as outbreaks among prisoners, sportsmen, men having sex with men and military personnel. The higher aggressiveness of these strains is due to the production of several toxins, mainly Panton- Valentine leukocidine. The detection of the gene that codes for this toxin is a distinctive feature of these strains. We report five patients with community acquired MRSA infections. The clinical presentation was a skin infection in all. One patient had a pleuropneumonia in addition. Apart for resistance to beta-lactam antimicrobials, the strains were resistant to erythromycin and ciprofloxacin. Patients were treated with vancomycin, clotrimoxazole or intravenous clindamycin with a good evolution. An epidemiological surveillance for community acquired MRSA strain infections should be started and measures to adequately treat infected patients and avoid dissemination should be implemented.

Staphylococcus aureus comunitario resistente a cloxacilina: comunicación de los primeros cinco casos descritos en Chile / Community acquired infections with methicillin resistant strains of Staphylococcus aureus: report of five cases

Community acquired infections with methicillin resistant strains of Staphylococcus aureus (MRSA) infections have a more aggresive clinical course and involve mostly skin and lungs. These infections appear as outbreaks among prisoners, sportsmen, men having sex with men and military personnel. The higher aggressiveness of these strains is due to the production of several toxins, mainly Panton- Valentine leukocidine. The detection of the gene that codes for this toxin is a distinctive feature of these strains. We report five patients with community acquired MRSA infections. The clinical presentation was a skin infection in all. One patient had a pleuropneumonia in addition. Apart for resistance to beta-lactam antimicrobials, the strains were resistant to erythromycin and ciprofloxacin. Patients were treated with vancomycin, clotrimoxazole or intravenous clindamycin with a good evolution. An epidemiológical surveillance for community acquired MRSA strain infections should be started and measures to adequately treat infected patients and avoid dissemination should be implemented.