Prevalence of Chagas heart disease in dilated cardiomyopathy / Prevalencia de cardiopatía chagásica en la miocardiopatía dilatada

Abstract Objectives: The main objective is to determine the prevalence of American trypanosomiasis in patients with dilated cardiomyopathy in a tertiary hospital in western Mexico. Methods: From January 1991 to February 2016, 387 consecutive patients with a confirmed diagnosis of dilated cardiomyopathy were included in the study. Cases with ventricular dilatation secondary to ischemic heart disease, valvular heart disease, hypertension, lung disease, pericardial disease, or congenital heart disease were excluded from the study. Diagnosis was made detecting antibodies against Trypanosoma cruzi with two different methods or parasite in blood. Results: Were included 387 patients with dilated cardiomyopathy, Chagas cardiomyopathy was confirmed in 6.9%, two patients in the acute phase (in one, suspected transfusion transmission was detected). Most patients were born in rural areas. About 96.2% showed congestive heart failure, only one patient with apical left ventricular aneurysm manifested palpitations. About 66% with right bundle branch block, left anterior fascicular block, or the association of both, in 14.8%, non-sustained ventricular tachycardia was found. Conclusions: Chagas cardiomyopathy is common in México, mainly in people who were born or lived during childhood in rural areas. It is a common cause of heart failure. Chagas’ heart disease should be suspected in patients receiving a blood transfusion, even without another epidemiological history.

Resumen Objetivo: El objetivo principal del estudio es conocer la prevalencia de tripanosomiasis americana en pacientes con cardiomiopatía dilatada, en un hospital de concentración en el occidente de México. Métodos: Desde enero de 1991 a febrero de 2016 se incluyeron 387 pacientes consecutivos con diagnóstico de cardiomiopatía dilatada, se excluyeron los casos con dilatación ventricular secundaria a cardiopatía isquémica, valvulopatías, hipertensión arterial sistémica, enfermedad pulmonar, enfermedad pericárdica o cardiopatías congénitas. El diagnóstico se realizó mediante la detección de anticuerpos anti-tripanosoma cruzi con 2 métodos positivos diferentes o con la detección del parásito en sangre. Resultados: Se incluyeron 387 paciente con cardiomiopatía dilatada, en el 6.9% se confirmó cardiopatía chagásica; dos pacientes en fase aguda (uno con sospecha de transmisión transfusional). La mayoría de los pacientes provenían de zonas rurales. El 96.2% de los casos presentó insuficiencia cardiaca congestiva, un paciente con aneurisma apical del ventrículo izquierdo solo manifestó palpitaciones. El 66% presentó bloqueo de la rama derecha del haz de His, hemibloqueo anterior izquierdo o la asociación de ambos, en el 14.8% se encontró taquicardia ventricular no sostenida. Conclusiones: La cardiopatía chagásica es frecuente en nuestro medio, principalmente en personas que nacieron o vivieron durante la infancia en áreas rurales. Es causa común de insuficiencia cardiaca. La cardiomiopatía chagásica debe sospecharse en pacientes que reciben transfusión sanguínea, incluso sin otros antecedentes epidemiológicos

Bacteremia por Acinetobacter baumannii en pacientes en estado crítico / Bacteremia caused by Acinetobacter baumannii among patients in critical care

Objetivo: Determinar la severidad y el comportamiento de las bacteremias por Acinetobacter baumannii (BAb). Métodos: Se revisaron de manera prospectiva todos los Acinetobacter baumannii aislados en una unidad de cuidados intensivos. Resultados: Se identificaron 46 pacientes con BAb y una tasa de BAb de 14 por mil ingresos. A. baumannii se adquirió en la unidad de cuidados intensivos en 85%. El periodo entre el ingreso y la BAb fue de 9±7 días. La BAb se presentó en 31 pacientes y bacteremia polimicrobiana en 15. Las manifestaciones clínicas de los 31 pacientes: choque séptico en 42%, sepsis severa en 42% y sepsis en 16%. Dos o más episodios de BAb ocurrieron en 13%. Se presentó resistencia a imipenem en 17% de los A. baumannii. La mortalidad para los pacientes con BAb fue de 45% y para bacteremia polimicrobiana de 40%. La mortalidad para los pacientes con choque séptico fue de 60%; 70% de los pacientes murió durante las primeras 72 horas seguidas a la BAb. Conclusiones: La distribución de los casos de BAb se presentó en forma continua con un patrón endémico. Sepsis severa y choque séptico fueron las principales manifestaciones de BAb. Las BAb se asocian con una tasa de mortalidad significativa.

OBJECTIVE: Determine the severity and the course of Acinetobacter baumannii blood infections (AbBI). METHODS: We carried out a prospective review of all Acinetobacter baumannii (A. baumannii) isolated from the Intensive Care Unit (ICU) of a medical facility. RESULTS: During the study period, 46 patients were identified with AbBI. The rate of AbBI was 14 per 1,000 admissions. A. baumannii was ICU acquired in 85% of cases studied. The median time frame between ICU admission and acquisition of AbBI was 9 +/- 7 days. 31 patients displayed blood infection (BI) by A. baumannii alone and 15 with polymicrobial BI. The clinical manifestation of the 31 patients with AbBI included the following symptoms: 42% presented with septic shock, 42% had severe sepsis and 16% had sepsis. Two or more episodes of AbBI were observed among 13% of patients. Of A. baumannii isolates, 17% were resistant to imipenem. Patient mortality with AbBI alone was 45% and 40% for polymicrobial BI. Patient mortality for septic shock was 60%, 70% died during the first 72 hrs after AbBI. CONCLUSIONS: AbBI displayed an endemic pattern during the study period. Severe sepsis and septic shock were the most common clinical presentations of AbBI. AbBI are associated with a significant increase in the death rate of patient in the ICU studied.

Asymptomatic bacteriuria and inflammatory response urinary tract infection of elderly ambulatory women in nursing homes

Background. Bacteriuria = 10 to fifth CFU/ml is evidence of urinary tract infection in the absence of associated signs or symptoms. The presence of pyuria with asymptomatic bacteriuria established the response of elderly women against microorganisms capable of causing invasiveness or tissue injury of the urinary tract. Methods. The association between bacteriuria and pyuria was determined in 178 elderly, ambulatory women without symptoms of urinary tract infection in seven nursing homes. Urine culture results were subsequently analyzed in conjunction with absolute leukocyte count in urine. In this cross-sectional study, asymptomatic bacteriuria in elderly women was classified with and without pyuria. Results. The prevalence of asymptomatic bacteriuria was found in 44 (24.7 percent) elderly women. The presence of pyuria had a sensitivity of 63.6 percent for bacteriuria and a specificity of 91 percent. The positive predictive value for the presence of pyuria predicting those with bacteriuria was 70 percent, and the negative predictive value for the absence of pyuria predicting those without bacteriuria was 88.4 percent. Escherichia coli was the most common organism isolated in 81.8 percent of the women. Conclusions. bacteriuria = 10 to fifth CFU/ml associated with pyuria was detected in 77 percent of elderly women with asymptomatic urinary tract infections bacteriuria of < 10 to fifth CFU/ml with pyuria proves less sensitive as an indicator of urinary tract infection. Elderly women with pyuria but without bacteriuria should be studied for other causes of urinary tractinflammation

Mucormicosis cutánea: reporte de 3 pacientes con diabetes mellitus / Cutaneous mucormycosis. A report of three cases in diabetes mellitus patients

Se describen tres mujeres diabéticas que desarrollaron mucormicosis cutánea en la espalda, pierna derecha y pierna izquierda, respectivamente. Las lesiones fueron únicas, entre 12 a 18 cm de diámetro, sin secreciones, con edema, eritema, calor, induración, necrosis importante y zonas isquémicas a su alrededor. Los exámenes histológicos mostraron extensa necrosis y numerosas hifas no septadas; en los cultivos creció Mucor spp. Todas las pacientes recibieron tratamiento con anfotericina B. En la primer paciente la enfermedad no se reconoció tempranamente y la paciente falleció; la segunda paciente requirió amputación de su pierna y la tercer paciente tuvo una buena respuesta. El diagnóstico temprano es primordial para evitar morbilidad y mortalidad por esta rara infección oportunista