[Recommendations of health care users and professionals to achieve a timely access to HIV diagnosis]. / Optimizando el acceso oportuno al test de ELISA para el diagnóstico del VIH: Recomendaciones desde los usuarios y profesionales de la Atención Primaria de Salud.

BACKGROUND: Early HIV (human immunodeficiency virus) diagnosis optimizes therapies aimed at reducing viral load, increasing survival, lowering health costs and reducing the number of people infected with the virus. In Chile, despite widespread and readily available HIV testing, infected people continue to get tested in a late fashion and are usually diagnosed in advanced stages of the disease. AIM: To determine the elements that facilitate or impede a timely HIV testing and to evaluate how to improve the access to HIV testing. MATERIAL AND METHODS: Descriptive, in-depth interviews to 30 participants with unknown serology, 15 participants diagnosed at AIDS stage and 15 health care professionals working at a primary healthcare settings. RESULTS: Users and professionals formulated three suggestions to improve timely access to ELISA test for HIV diagnosis. Namely, to inform users and professionals about the characteristics of the disease and diagnostic test, to offer fast and easy access to HIV testing, and to train the whole healthcare team about obtaining informed consent for testing. CONCLUSIONS: These recommendations should be implemented at healthcare centers to attain a timely HIV diagnosis.

[Identification of educational needs among patients with HIV and their health care providers]. / Necesidades educativas de un grupo de personas viviendo con VIH: diagnóstico basado en la perspectiva de los usuarios y de los profesionales que los atienden.

BACKGROUND: The success of educational interventions depends on the integration of educational programs into clinical practice. AIM: To determine the educational needs and perceived barriers of people living with HIV (PHIV) and their health care providers (HCP). MATERIAL AND METHODS: Qualitative study conducted in 60 PHIV and 10 HCP. For data collection, a semi-structured in-depth interview was applied, addressing the educational needs (content, methodology, person, time, physical location) and identified barriers to implement an educational program for PHIV Content analysis technique was used for data analysis. RESULTS: PHIV and their HCP identified the same educational needs as the following: general-related content, psychological, sexual and secondary prevention aspects of the disease. Individual sessions with written material and web pages were identified as important resources to support education. Both PHIV and professionals expressed their willingness to participate in educational programs, but the most commonly identified barrier was lack of time. CONCLUSIONS: This study identifies the key elements to include in an educational program for Chilean PHIV from the user and professional perspective.

[Pandemic influenza A (H1N1) 2009: epidemiology, clinical features and differences with seasonal influenza in Chile]. / Influenza pandémica A (H1N1) 2009: epidemiología, características clínicas y diferencias con influenza estacional en Chile.

UNLABELLED: Pandemic influenza A (H1N1) 2009 raised questions regarding differences with seasonal influenza. OBJECTIVES: To describe the clinical features of pandemic influenza and compare them to seasonal influenza. PATIENTS Y METHODS: A descriptive study that compared hospitalized adults was done between patients with confirmed pandemic influenza in the Hospital Clínico Universidad Católica in Santiago, Chile, from May to July 2009 and 95 confirmed historic cases of seasonal influenza. RESULTS: 54 patients with pandemic influenza were included, 51.9% were male, age of 52.8 ± 19.5 years old; 79.6% had chronic diseases; 16.7% were immunocompromised patients and 7.4% of pregnant women. 25.9% of the patients acquired the infection during the hospitalization. 31.5% were admitted to intermediate/intensive care units. Pneumonia was diagnosed in 37%, and the mortality rate was 3.7%. The comparison between pandemic and seasonal influenza showed less proportion of patient > 65 years of age (31.5% vs. 68%; p < 0.0001); double number of nosocomial acquisition and more cases of pneumonia and death. CONCLUSIONS: The pandemic influenza infection affected younger people and was related with more nosocomial cases, pneumonia and mortality rates than seasonal influenza.

[Evaluation of an IgG avidity commercial test: contribution to diagnosis of primary infection caused by Toxoplasma gondii]. / Evaluación de un test comercial de avidez de IgG: Aporte al diagnóstico de primoinfección por Toxoplasma gondii.

INTRODUCTION: Toxoplasmosis (T) is a major chronic parasitic infection in immunocompromised patients and pregnant women. It is important to discriminate between acute phase (AT) and chronic phase (CT). Diagnosis is serological in immunocompetent patients (concentration of IgG and IgM). OBJECTIVE: To evaluate the utility of an IgG avidity test (A-IgG) to identify the acute and chronic stage. Avidity is the strength of affinity between a specific immunoglobulin and the protein antigenic epitope of the infecting agent, an affinity that increases over time. PATIENTS AND METHODS: We used a qualitative kit that measures the avidity of IgG, discriminating the two phases. In 35 patients with clinical diagnosis of AT and/or CT, IgG, IgM and IgG A (VIDAS®) were performed. RESULTS: Patients with AT were positive for IgM and IgG, but presented weak avidity. In the 21 cases with CT, 52% (n: 11) were IgM positive and 100% (n: 21) had positive IgG with strong avidity. DISCUSSION: The results confirm that the test of A-IgG may be useful in the diagnosis of AT, and has 100% concordance with reference test (qualitative IgM + quantitative IgG). The result is available within 24 hrs, and may be useful in diagnosis of AT in pregnant women.

[Hansen's disease: case report and review of literature]. / Enfermedad de Hansen: Revisión a propósito de un caso.

Leprosy is a granulomatous disease affecting the skin and peripheral nerves caused by Mycobacterium leprae. The range of clinical forms varying from tuberculoid to lepromatous leprosy results from variations in the cellular immune response to the mycobacterium. Despite available combined drug-therapy, it continues to be a significant public health problem, carrying a strong stigma. Although recently there has been no native cases in Chile, a few imported cases have been diagnosed. We present a 56-year-old man who had lived in Paraguay for 8 years, and presented with leprosy 6 years after returning to Chile. The biology of leprosy, clinical features of the disease, current diagnostic criteria and approaches to treatment are discussed.

[Usefulness of the determination of IgG and IgM antibodies by ELISA and immunocapture in a clinical series of human brucellosis]. / Utilidad de la determinación de anticuerpos IgG e IgM por ELISA e inmunocaptura en una serie clínica de brucelosis humana.

INTRODUCTION: The diagnostic difficulties of brucellosis makes the evaluation of new diagnostic tests necessary. OBJECTIVES: Evaluation of different commercial tests in the serological diagnosis of brucellosis by ELISA and immunocapture antibodies in a clinical series of patients with brucellosis of the Health Network of the Catholic University of Chile. METHODS: All the serums received in the Laboratory of Microbiology for suspicion of brucellosis during five years were studied. Two groups were obtained, one that fulfilled diagnostic criteria for brucellosis [clinical evidence, and/or positive blood culture and/or seroagglutination test (SAT) in titers > 1/160] and the control group. Each serum sample was analyzed using irnmunocapture-agglutination test (Brucellacapt), ELISA IgM and IgG. RESULTS: Of 10 patients with brucellosis, the serologic results were: 8/10 positives for ELISA IgG, 7/10 for Brucellacapt and SAT, and 5/10 for ELISA IgM. DISCUSSION: ELISA IgG alone was superior than SAT. The combination ELISA IgG/ Brucellacapt reaches the best detection performance (9/10) and can be an alternative to SAT.

[National consensus for management of community acquired pneumonia in adults]. / Consenso Chileno 2005: Manejo de la neumonía del adulto adquirida en la comunidad.

Community acquired pneumonia (CAP) is an acute respiratory infection that affects pulmonary parenchyma, and is caused by community acquired microorganisms. In Chile, pneumonia represents the main cause of death due to infectious diseases and is the third specific cause of mortality in adults. In 1999, an experts committee in representation of "Sociedad Chilena de Enfermedades Respiratorias", presented the first National Guidelines for the Treatment of Adult Community Acquired Pneumonia, mainly based in foreign experience and documents, and adapted it to our National Health System Organization. During the last decade, impressive epidemiological and technological changes have occurred, making the update of guidelines for treatment of NAC by several international scientific societies, necessary. These changes include: new respiratory pathogens that are being identified in CAP and affect adult patients (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila); the increasing senescent adult population that carries multiple co-morbidities; the emergence of antimicrobial resistance among respiratory pathogens associated to massive antibiotic prescription; the development by the pharmaceutical industry of new drugs that are effective for pneumonia treatment (macrolides, ketolides and respiratory fluorquinolones); and the development of new diagnostic techniques for detection of antigens, antibodies, and bacterial DNA by molecular biology, useful in respiratory infections. Based on these antecedents, an Advisory Committee of "Sociedad Chilena de Enfermedades Respiratorias" and "Sociedad Chilena de Infectología" has reviewed the national and international evidence about CAP management in adults in order to update clinical recommendations for our country.

[Treatment of community-acquired pneumonia in adults]. / Tratamiento de la neumonía del adulto adquirida en la comunidad.

UNLABELLED: Appropriate antibiotic treatment reduces the duration of symptoms associated to pneumonia, the risk of complications and mortality. In most cases, it is not possible to identify the etiologic agent so antibiotic treatment is empirically prescribed. In Chile, one third of Streptococcus pneumoniae strain isolates has diminished susceptibility to penicillin; in-vitro erythromycin resistance is about 10-15% and cefotaxime resistance 2-10%. It is recommended to classify patients with community acquired pneumonia in four risk categories: Group 1: patients under 65 years without co-morbidities, in ambulatory attendance. TREATMENT: oral amoxicillin 1 g TID, 7 days. Group 2: patients over 65 years and / or co-morbidities, in ambulatory attendance. TREATMENT: oral amoxicillin/clavulanate 500/125 mg TID or 875/125 mg BID, or cefuroxime 500 mg BID, 7 days. Group 3: patients admitted to general wards with criteria of moderate severity. TREATMENT: ceftriaxone 1-2 g once a day or cefotaxime 1 g TID, IV, 7-10 days. Group 4: patients with severe CAP that must be interned into ICU. TREATMENT: ceftriaxone 2 g once a day or cefotaxime 1 g TID, IV, associated to erythromycin 500 QID, levofloxacin 500-1.000 mg once a day, or moxifloxacin 400 mg/once a day, IV, 10-14 days. In the presence of allergy to or treatment failure with betalactam drugs and/or positive serology for Mycoplasma, Chlamydia or Legionella sp it is recommended to add: erythromycin 500 mg QID, IV or oral, oral clarithromycin 500 mg BID, or oral azythromycin 500 mg once a day.

Composición lipídica y evaluación de las actividades antioxidante y leishmanicida del basidiomiceto Ganoderma sp / Lipid composition and evaluation of the antioxidant and leishmanicidal activities of the basidiomycete Ganoderma sp

Introducción: los hongos del género Ganoderma han sido utilizados para el cuidado de la salud en la medicina tradicional asiática por más de 2000 años. Desde 1980 los estudios químicos han reportado un sin número de metabolitos secundarios con propiedades bioactivas. Objetivo: identificar compuestos lipídicos en el extracto etanólico del hongo Ganoderma sp., además de evaluar sus actividades antioxidante y leishmanicida. Métodos: la extracción de las fracciones lipídicas presentes en el cuerpo fructífero de Ganoderma sp. Se realizó por Cromatografía en Columna. La elucidación estructural se determinó por Espectrometría de Masas y Resonancia Magnética Nuclear. La actividad antioxidante del extracto etanólico fue evaluada con las metodologías del radical 2,2-difenil-1-picrilhidrazil (DPPH) y el radical catiónico 2,2'-azinobis (3-etilbenzotiazolina-6-ácido sulfónico) (ABTS); la actividad leishmanicida por citometría de flujo y la actividad citotóxica usando el ensayo colorimétrico de bromuro de 3-(4,5-dimetil-tiazol-2-il)-2,5-difenil tetrazolio (MTT) sobre la línea celular U937. Resultados: diecinueve esteres metílicos y ergosterol fueron identificados por espectrometría de masas en el extracto etanólico. Un compuesto triterpenoidal se elucidó usando Espectroscopia de Resonancia Magnética Nuclear. Los valores de concentración media inhibitoria (IC 50) de la actividad antioxidante del extracto etanólico para las metodologías de los radicales DPPH y ABTS fueron de 85,63 µg/mL y 62,82 µg/mL, respectivamente. Los valores de las actividades citotóxica y leishmanicida fueron > 200,0 µg/mL y 21,5 µg/mL ± 4,4 respectivamente. Conclusiones: las estructuras de los derivados de ácidos grasos elucidados corresponden a compuestos con diferentes grados de insaturación. En este estudio se realizó el reporte de la Ganoderona A, como compuesto triterpenoidal. La elevada actividad antioxidante en relación a otros trabajos sugiere que este organismo es una fuente importante de metabolitos secundarios con propiedades captadoras de radicales libres, aunque los valores de actividad leishmanicida no fueron significativos se recomienda continuar con el estudio de otras particiones del extracto etanólico(AU)

Introduction: Fungi from the genus Ganoderma have been used in Asian traditional medicine for more than 2 000 years. Since the year 1980 chemical studies have reported a large number of secondary metabolites with bioactive properties. Objective: Identify lipid compounds in ethanolic extract from the fungus Ganoderma sp. and evaluate their antioxidant and leishmanicidal activities. Methods: Extraction of lipid fractions from the fruiting body of Ganoderma sp. was conducted by column chromatography. Structural features were determined by mass spectrometry and nuclear magnetic resonance. Antioxidant activity of the ethanolic extract was evaluated with the methodologies for radical 2,2-diphenyl-1-picrylhydrazyl (DPPH) and cationic radical 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid (ABTS); leishmanicidal activity by flow cytometry, and cytotoxic activity with the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide colorimetric assay (MTT) on cell line U937. Results: Nineteen methyl esters and ergosterol were identified by mass spectrometry in the ethanolic extract. A triterpenoid compound was identified by nuclear magnetic resonance spectroscopy. Mean inhibitory concentration values (IC50) for antioxidant activity of the ethanolic extract using the methodologies for radicals DPPH and ABTS were 85.63 µg/ml and 62.82 µg/ml, respectively. Values for cytotoxic and leishmanicidal activities were > 200.0 µg/ml and 21.5 µg/ml ± 4.4, respectively. Conclusions: The structure of the fatty acid derivatives identified corresponds to compounds with varying degrees of unsaturation. The study included the report of Ganoderma A as a triterpenoid compound. Antioxidant activity was found to be higher than in previous studies, suggesting that this organism is an important source of secondary metabolites with free radical scavenging properties. Although leishmanicidal activity values were not found to be significant, it is recommended to study other partitions of the ethanolic extract(AU)

Optimizando el acceso oportuno al test de ELISA para el diagnóstico del VIH: Recomendaciones desde los usuarios y profesionales de la Atención Primaria de Salud / Recommendations of health care users and professionals to achieve a timely access to HIV diagnosis

Background: Early HIV (human immunodeficiency virus) diagnosis optimizes therapies aimed at reducing viral load, increasing survival, lowering health costs and reducing the number of people infected with the virus. In Chile, despite widespread and readily available HIV testing, infected people continue to get tested in a late fashion and are usually diagnosed in advanced stages of the disease. Aim: To determine the elements that facilitate or impede a timely HIV testing and to evaluate how to improve the access to HIV testing. Material and Methods: Descriptive, in-depth interviews to 30 participants with unknown serology, 15 participants diagnosed at AIDS stage and 15 health care professionals working at a primary healthcare settings. Results: Users and professionals formulated three suggestions to improve timely access to ELISA test for HIV diagnosis. Namely, to inform users and professionals about the characteristics of the disease and diagnostic test, to offer fast and easy access to HIV testing, and to train the whole healthcare team about obtaining informed consent for testing. Conclusions: These recommendations should be implemented at healthcare centers to attain a timely HIV diagnosis.

[Hepatitis B, C, Treponema pallidum and Toxoplasma gondii co-infections in HIV infected patients]. / Coinfecciones por virus hepatitis B, virus hepatitis C, Treponema pallidum y Toxoplasma gondii en la cohorte de pacientes VIH positivos en control en la Pontificia Universidad Católica de Chile.

BACKGROUND: Some infections share common modes of transmission with HIV and have the potential to change the course of the latter. AIM: To assess the prevalence of hepatitis B virus (HBV) hepatitis C virus (HCV), Treponema palladium and Toxoplasmosis gondii co-infections in HIV-1 infected patients followed at a university hospital. MATERIAL AND METHODS: Clinical records of HIV-positive individuals were reviewed. The analysis included: demographical data, hepatitis B surface antigen (HBsAg), IgM and IgG anti-HBc, antibodies, anti-HCV antibodies, RPR or VDRL test and IgG anti Tgondii antibodies. RESULTS: Three hundred ninety five patients (aged 16 to 89 years, 359 males) were included in the review. Seventy nine percent had been tested for HBV status with HBsAg, and the global HIV-HBV co-infection prevalence was 6.1%. A subgroup of 190 individuals were tested for HBV infection with HBsAg and IgM/IgG anti-HBc markers. Of these, 46% fulfilled co-infection criteria: eight with acute hepatitis B, 11 with chronic hepatitis B and 69 with inactive HBV infection. The frequency of HIV-HBV co-infection was 48% and 22% among men and women respectively (NS). HCV-HN co-infection was detected in 3%, syphilis-HIV co-infection in 21% and T gondii-HIV co-infection in 26%. CONCLUSIONS: In this cohort, HIV infection is accompanied by a high prevalence of other co-infections, particularly HBV among men.

Necesidades educativas de un grupo de personas viviendo con VIH: diagnóstico basado en la perspectiva de los usuarios y de los profesionales que los atienden / Identification of educational needs among patients with HIV and their health care providers

Background: The success of educational interventions depends on the integration of educational programs into clinical practice. Aim: To determine the educational needs and perceived barriers of people living with HIV (PHIV) and their health care providers (HCP). Material and Methods: Qualitative study conducted in 60 PHIV and 10 HCP. For data collection, a semi-structured in-depth interview was applied, addressing the educational needs (content, methodology, person, time, physical location) and identified barriers to implement an educational program for PHIV Content analysis technique was used for data analysis. Results: PHIV and their HCP identified the same educational needs as the following: general-related content, psychological, sexual and secondary prevention aspects of the disease. Individual sessions with written material and web pages were identified as important resources to support education. Both PHIV and professionals expressed their willingness to participate in educational programs, but the most commonly identified barrier was lack of time. Conclusions: This study identifies the key elements to include in an educational program for Chilean PHIV from the user and professional perspective.

Influenza pandémica A (H1N1) 2009: epidemiología, características clínicas y diferencias con influenza estacional en Chile / Pandemic influenza A (H1N1) 2009: epidemiology, clinical features and differences with seasonal influenza in Chile

Pandemic influenza A (H1N1) 2009 raised questions regarding differences with seasonal influenza. Objectives: To describe the clinical features of pandemic influenza and compare them to seasonal influenza. Patients y Methods: A descriptive study that compared hospitalized adults was done between patients with confirmed pandemic inluenza in the Hospital Clínico Universidad Católica in Santiago, Chile, from May to July 2009 and 95 confirmed historic cases of seasonal influenza. Results: 54 patients with pandemic influenza were included, 51.9 percent were male, age of 52.8 ± 19.5 years old; 79.6 percent had chronic diseases; 16.7 percent were immunocompromised patients and 7.4 percent of pregnant women. 25.9 percent of the patients acquired the infection during the hospitalization. 31.5 percent were admitted to intermediate/intensive care units. Pneumonia was diagnosed in 37 percent, and the mortality rate was 3.7 percent. The comparison between pandemic and seasonal influenza showed less proportion of patient > 65 years of age (31.5 percent vs. 68 percent; p < 0.0001); double number of nosocomial acquisition and more cases of pneumonia and death. Conclusions: The pandemic inluenza infection affected younger people and was related with more nosocomial cases, pneumonia and mortality rates than seasonal inluenza.

La pandemia de inluenza A (H1N1) 2009 generó preguntas sobre sus diferencias con influenza estacional. Objetivos: Describir las características de influenza pandémica y comparar con influenza estacional. Pacientes y Métodos: Estudio descriptivo de casos confirmados de influenza pandémica en adultos internados en el Hospital Clínico de la Pontificia Universidad Católica entre mayo y julio de 2009, comparado con 95 casos históricos de influenza estacional. Resultados: 54 pacientes con influenza pandémica, 51,9 por ciento género masculino, edad 52,8 ± 19,5 años; 79,6 por ciento presentaban co-morbilidades; 16,7 por ciento inmunocomprometidos, 7,4 por ciento mujeres embarazadas, 25,9 por ciento de adquisición nosocomial, 31,5 por ciento requirió cuidados intensivos/intermedios. Se diagnosticó neumonía en 37 por ciento y la mortalidad global fue 3,7 por ciento. En la comparación con inluenza estacional, la pandémica afectó menos pacientes > de 65 años (31,5 vs 68 por ciento, p < 0,0001), dobló los casos con adquisición nosocomial y hubo más casos de neumonía y muertes. Conclusiones: La infección por inluenza pandémica afectó a un grupo de menor edad y generó mayor transmisión nosocomial, neumonía y muerte que la inluenza estacional.

[Malaria: report of 12 non autochthonous cases]. / Malaria: revisión retrospectiva de 12 casos no autóctonos en Chile.

Malaria is a protozoan infection caused by four Plasmodia species transmitted by female Anopheles mosquito. Nearly 40% of the world population is at risk of acquiring the disease because of increasing resistance to treatment, climate changes and travels to endemic zones. We report twelve patients with diagnosis of malaria, supported by the identification of parasites on blood smear. All cases had traveled to endemic zones (Peru, Ecuador, Central America, Africa), but only three used chemoprophylaxis. Seven cases were infected with Plasmodium vivax and five cases with P. falciparum. Three of latter required intensive care. All patients were treated with standard drugs according to the severity and Plasmodium specie, with excellent results and no mortality.

Diagnóstico de la infección por Treponema pallidum en pacientes con sífilis temprana y neurosífilis mediante reacción de la polimerasa en cadena / Laboratory diagnosis of Treponema pallidum infection in patients with early syphilis and neurosyphilis through a PCR-based test

Syphilis is a sexually transmitted disease caused by Treponema pallidum. The diagnosis is based mainly in clinical presentation and non-specific assays. PCR-based diagnosis has been suggested as an attractive alternative method. The aim of this study was the validation of a PCR-based test for the diagnosis of early syphilis (ES) and neurosyphilis (NS). Clinical samples of mucocutaneous lesions and cerebrospinal fluid (CSF) specimens from patients previously diagnosed for ES and NS respectively using an enlarged gold standard, were tested by PCR. The reaction was done using primers targeting the tpN47gene. Twenty out of 21 mucocutaneous samples from patients diagnosed with ES were positive by PCR, with a clinical sensitivity of 95 percent. Four out of 8 CSF samples from patients previously diagnosed with NS were positive by PCR, with a clinical sensitivity of 50 percent. The clinical specificity for both ES and NS was 100 percent. The PCR sensitivity and specificity for mucocutaneous samples allowed us to implement this assay in our laboratory for routine diagnosis. Although the sensitivity of the PCR in CSF was low, it may be useful to support clinical diagnosis.

La sífilis es una enfermedad de transmisión sexual producida por Treponema pallidum, cuyo diagnóstico se realiza presuntivamente basándose en aspectos clínicos y análisis de especificidad limitada. La reacción de la polimerasa en cadena (RPC) ha sido planteada como una alternativa diagnóstica de mayor sensibilidad y especificidad. El objetivo de este trabajo fue validar una RPC para el diagnóstico de sífilis temprana (ST) y neurosífilis (NS). Se utilizaron muestras de lesiones muco-cutáneas y de LCR de pacientes con sospecha de cursar ST y NS respectivamente, previamente diagnosticados, utilizando un estándar de oro ampliado. La RPC fue realizada con partidores dirigidos al gen tpN47. De las 21 muestras de pacientes con ST, la RPC resultó positiva en 20, lo que resulta en una sensibilidad clínica de 95 por ciento. De las 8 muestras de pacientes con NS, la RPC resultó positiva en 4, obteniéndose una sensibilidad clínica de 50 por ciento. La especificidad clínica para ST y NS fue de 100 por ciento. La excelente sensibilidad y especificidad de la RPC para muestras muco-cutáneas permitió la exitosa implementación de este análisis en nuestro laboratorio para el diagnóstico de rutina. Si bien la sensibilidad de la RPC en LCR es baja, es muy útil para apoyar el diagnóstico clínico.

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.

Evaluación de un test comercial de avidez de IgG: Aporte al diagnóstico de primoinfección por Toxoplasma gondii / Evaluation of an IgG avidity commercial test: Contribution to diagnosis of primary infection caused by Toxoplasma gondii

Introduction: Toxoplasmosis (T) is a major chronic parasitic infection in immunocompromised patients and pregnant women. It is important to discriminate between acute phase (AT) and chronic phase (CT). Diagnosis is serological in immunocompetent patients (concentration of IgG and IgM). Objective: To evaluate the utility of an IgG avidity test (A-IgG) to identify the acute and chronic stage. Avidity is the strength of affinity between a specific immunoglobulin and the protein antigenic epitope of the infecting agent, an affinity that increases over time. Patients and Methods: We used a qualitative kit that measures the avidity of IgG, discriminating the two phases. In 35 patients with clinical diagnosis of AT and/or CT, IgG, IgM and IgG A (VIDAS®) were performed. Results: Patients with AT were positive for IgM and IgG, but presented weak avidity. In the 21 cases with CT, 52 percent (n: 11) were IgM positive and 100 percent (n: 21) had positive IgG with strong avidity. Discussion: The results confirm that the test of A-IgG may be useful in the diagnosis of AT, and has 100 percent concordance with reference test (qualitative IgM + quantitative IgG). The result is available within 24 hrs, and may be useful in diagnosis of AT in pregnant women.

Introducción: Toxoplasmosis (T) es una infección parasitaria crónica importante en pacientes inmunocompro-metidos y mujeres embarazadas. Es relevante discriminar entre fase aguda (TA) y fase crónica (TC). Su diagnóstico es serológico en inmunocompetentes (detección de IgG e IgM). Objetivo: Evaluar la utilidad del test de avidez IgG (A-IgG) para identificar la fase aguda y o crónica. Avidez es la fuerza de afinidad entre una inmunoglobulina específica y el epítope de la proteína antigénica del agente infectante, afinidad que aumenta con el tiempo. Pacientes y Métodos: Se usó un test cualitativo que mide la avidez de IgG, discriminando las dos fases. A 35 pacientes con diagnóstico clínico de TA y o TC, se les realizó IgG, IgM e A-IgG en Equipo VIDAS®. Resultados: Los pacientes con TA fueron positivos para IgM e IgG y presentaron avidez débil. Los 21 casos con TC 52 por ciento (n: 11) tuvieron IgM positivo y 100 por ciento (n: 21) tuvo IgG positiva con avidez fuerte. Discusión: Los resultados confirman que el test de A-IgG puede ser de gran utilidad en el diagnóstico de TA, concordancia: 100 por ciento con test de referencia (IgM cualitativa + IgG cuantitativa). El resultado está disponible en menos de 24 hrs, pudiendo ser útil en el diagnóstico de TA en mujeres embarazadas.

Coinfecciones por virus hepatitis B, virus hepatitis C, Treponema pallidum y Toxoplasma gondii en la cohorte de pacientes VIH positivos en control en la Pontificia Universidad Católica de Chile / Hepatitis B, C, Treponema pallidum and Toxoplasma gondii co-infections in HIV infected patients

Background: Some infections share common modes of transmission with HIV and have the potential to change the course of the latter. Aim: To assess the prevalence of hepatitis B virus (HBV) hepatitis C virus (HCV), Treponema palladium and Toxoplasmosis gondii co-infections in HIV-1 infected patients followed at a university hospital. Material and methods: Clinical records of HIV-positive individuals were reviewed. The analysis included: demographical data, hepatitis B surface antigen (HBsAg), IgM and IgG anti-HBc, antibodies, anti-HCV antibodies, RPR or VDRL test and IgG anti Tgondii antibodies. Results: Three hundred ninety five patients (aged 16 to 89years, 359 males) were included in the review. Seventy nine percent had been tested for HBV status with HBsAg, and the global HIV-HBV co-infection prevalence was 6.1 percent. A subgroup of190 individuals were tested for HBV infection with HBsAg and IgM/IgG anti-HBc markers. Of these, 46 percent fulfilled co-infection criteria: eight with acute hepatitis B, 11 with chronic hepatitis B and 69 with inactive HBV infection. The frequency of HIV-HBV co-infection was 48 percent and 22 percent among men and women respectively (NS). HCV-HN co-infection was detected in 3 percent, syphilis-HIV co-infection in 21 percent and T gondii-HIV co-infection in 26 percent. Conclusions: In this cohort, HIV infection is accompanied by a high prevalence of other co-infections, particularly HBV among men.