Epidemiología molecular de la criptococosis en un Hospital de enfermedades infecciosas de la Ciudad de Buenos Aires: análisis de 25 años / Molecular epidemiology of cryptococcosis in an infectious diseases hospital from the city of Buenos Aires: A 25 years experience

La criptococosis es una micosis grave de distribución universal, que afecta principalmente a huéspedes inmunocomprometidos. Es una de las principales causas de morbilidad y mortalidad en los pacientes infectados con el virus de la inmunodeficiencia humana (HIV). Provoca al menos 620 000 muertes al año, representando entre el 13% al 44% de la mortalidad en pacientes HIV positivos según datos de cohortes correspondientes a países en desarrollo. (1, 2) La letalidad de la criptococosis meníngea en estudios de Argentina y Brasil muestra valores que van desde el 26% hasta el 63%. El complejo Cryptococcus neoformans/ Cryptococcus gattii, es el responsable de esta enfermedad. Existen alrededor de 70 especies pero solo dos de ellas son patógenas para el hombre: C. neoformans y C. gattii. Se reconocen 8 genotipos de este complejo, C. neoformans: VNI y VNII (C. neoformans var. grubii), VNIII (C. neoformans híbrido intervariedad AD), VNIV (C. neoformans var. neoformans) y C. gattii: genotipos VGI, VGII, VGIII y VGIV. Se han descripto híbridos interespecie VNIV/VGI, VNI/VGI, VNI/VGII. Se estudiaron 207 aislamientos de Cryptococcus, elegidos aleatoriamente, de un total de 2593 pacientes con diagnóstico de criptococosis diseminada. A los mismos se les realizó la genotipificación mediante una PCR-RFLP del gen URA5, y posterior digestión enzimática con enzimas Sau96I y HhaI. De las 207 cepas estudiadas, 174 fueron VNI (84,05%), 14 VNII (6,76%), 10 VNIII (4,83%), 2 VNIV (0,97%), 3 VGI (1,45%), 3 VGII de (1,45%) y 1 VGIII (0,49%).

Cryptococcosis is a severe worldwide mycosis, which mainly affects immunocompromised hosts and is a major cause of morbidity and mortality in HIV-infected patients. It causes 620,000 annual deaths, accounting for 13-44 % of mortality in HIV-positive individuals in developing countries. Mortality rates of meningeal cryptococcosis in studies from Argentina and Brazil go from 26 to 63 %. Cryptococcus neoformans/Cryptococcus gattii is the species complex responsible for this disease. There are about 70 species, however, only two are human pathogens: C. neoformans and C. gattii. C. neoformans genotypes are VNI and VNII (C. neoformans var. grubii), VNIII (C. neoformans intervariety hybrid AD), VNIV (C. neoformans var. neoformans). C. gattii genotypes are VGI, VGII, VGIII and VGIV. Interspecies hybrids were described: VNIV/VGI, VNI/VGI, VNI/ VGII. A total of 207 Cryptococcus isolates were randomly selected from 2593 patients with diagnosis of disseminated cryptococcosis. Genotyping was performed by PCRRFLP of UR A5 gene with restriction enzyme digestion using Sau96I and HhaI enzymes. Among the 207 studied isolates, 174 resulted VNI (84.05%), 14 VNII (6.76%), 10 VNIII (4.83%), 2 VNIV (0.97%), 3 VGI (1.45%), 3 VGII (1.45%) and 1 VGIII (0.49%).

Paracoccidioidomicosis en un hospital monovalente / PARACOCCIDIOIDIOMYCOSIS IN A SINGLE SPECIALITY HOSPITAL

La Paracoccidioidomicosis es la micosis endémica más frecuente en América latina en enfermos HIV negativos. Objetivo: analizar las características clínicas, epidemiológicas, evolución y tratamiento de los pacientes con diagnóstico de paracoccidioidomicosis asistidos en un hospital de referencia en enfermedades infecciosas en un período de 10 años. Materiales y métodos: Estudio descriptivo y retrospectivo. Se analizaron las historias clínicas de 70 pacientes con diagnóstico de paracoccidioidomicosis en el período comprendido entre Enero de 2001 y Diciembre de 2010. Resultados: se incluyeron 70 pacientes. Cincuenta y nueve presentaron la forma crónica de la enfermedad, siete la infanto-juvenil y solo cuatro resultaron positivos para el HIV. La mayoría de los enfermos fueron de nuestro país y habían nacido en Chaco y Misiones. Veintiséis eran oriundos de Paraguay. El 81,4% de los casos tuvieron compromiso pulmonar y el patrón radiológico hilio-fugal, en "alas de mariposa", fue el más frecuente. Se observaron lesiones cutáneo-mucosas en 38,57% de los enfermos. El examen directo en fresco de esputo y la escarificación de las lesiones mucocutáneas resultó ser la prueba más útil para el diagnóstico de esta micosis endémica. La serología fue positiva en el 81,3 % de los pacientes con formas crónicas y en el 42,8% de la forma infanto-juvenil. La mayoría de los enfermos fueron tratados con itraconazol; sólo dos fallecieron. Conclusión: El diagnóstico de la paracoccidioidomicosis se basa principalmente en el examen microscópico directo; los cultivos de muestras clínicas pueden fallar. La paracoccidioidomicosis debe incluirse en el diagnóstico diferencial de los pacientes que provengan de áreas endémicas y presenten compromiso de piel, mucosas o del aparato respiratorio asociado a un síndrome infeccioso inespecífico

Paracoccidioidomycosis is the most frequent endemic mycosis in Latin America in HIV negative patients. Objective: to analyze the clinical, epidemiological and treatment characteristics and the evolution of patients with diagnosis of paracoccidioidomycosis. Materials and methods: Descriptive and retrospective study. The clinical records of 70 patients with paracoccidioidomycosis were analyzed in the period between January 2001 and December 2010. Results: 70 patients were included. Fifty-nine presented the chronic form, seven had the juvenile (acute) clinical picture and only four were HIV positive. The majority of the Argentinian patients had been born in Chaco and Misiones provinces. Twenty-six were from Paraguay. 81.4% of the patients had lung involvement, the "butterfly wing" pattern was the most frequent. Muco cutaneous lessions were observed in 38.57% of the patients. Wet mount microscopy examination of sputum and mucocutaneous scarification proved to be the most useful tests for the disease diagnosis Serology tests were positive in 81.3% of patients with the chronic form and in 42.8% of those with the juvenile clinical presentation. Most of the patients were treated with itraconazole. Only two deceased. Conclusion: The diagnosis of paracoccidiodomycosis is mainly based on direct microscopic examination of clinical smears. Cultures of clinical samples may fail. Paracoccidioidomycosis should be included in the differential diagnosis of patients who come from the endemic area and present skin, mucous membranes or respiratory system compromise associated with a non-specific infectious syndrome

Detección de adenovirus en niños menores de 5 años con síndrome diarreico: Estado Zulia-Venezuela / Adenovirus Detection in Children Under 5 Years With Diarrheal Syndrome: State of Zulia, Venezuela

Las diarreas son una de las principales causas de enfermedad infantil en todo el mundo, especialmente en países en vías desarrollo, en donde las enfermedades diarreicas representan un factor muy importante de mortalidad infantil, alcanzando, principalmente, a menores de 5 años de edad. Se calcula que los adenovirus pueden ser el segundo agente causal de las diarreas agudas después del rotavirus y que contribuye entre el 5 y 20% de los niños hospitalizados por diarrea. El objetivo del estudio fue detectar la presencia de adenovirus entéricos 40 y 41, utilizando la técnica de PCR en muestras de heces diarreicas de 190 niños de ambos sexos, menores de 5 años de edad, de diferentes municipios y centros de salud del estado Zulia, recolectadas en el periodo de Enero de 2011 a Noviembre 2013. Se encontró un 22,10% (42/190) de positividad en las muestras estudiadas, lo que demostró que este virus es causa de gran parte de los casos de diarreas en los niños. Según la procedencia el mayor número de casos estuvo en el Municipio Jesús Enrique Lossada con un 28,57%. Adenovirus predominó en el grupo lactante menor con un 52,38% (22/127), con diferencias significativas (p<0,05) con el resto de los grupos etarios. El sexo masculino fue el más afectado con un 57,14% (24/92) con respecto al femenino. La relación en cuanto a positividad para el virus y las manifestaciones clínicas, se destacan, diarrea en 42/42 (100%), seguido de vómitos 28/42 (73,80%). El presente estudio indica que adenovirus 40 y 41 son agentes etiológicos importantes de las diarreas en la población infantil estudiada.

Diarrhea is one of the main causes of childhood illness worldwide, especially in developing countries, where diarrheal diseases represent a very important factor in infant mortality, reaching primarily, those under 5 years. It is estimated that adenoviruses can be the second causal agent for acute diarrhea after rotaviruses and that they contribute between 5 and 20% of the children hospitalized for diarrhea. The aim of this study was to detect the presence of enteric adenoviruses 40 and 41 using the PCR technique in diarrheal stool samples of 190 children of both sexes under 5 years old. Different municipalities and health centres in Zulia collected samples from January, 2011, to November, 2013. The study found 22.10% (42/190) positive reactions in the samples studied, demonstrating that this virus causes a great part of the diarrheal cases in children. According to source, the highest number of cases was in the Jesus Enrique Lossada municipality with 28.57%. Adenovirus dominated the nursing infant group with 52.38% (22/127), showing significant differences (p<0.05) when compared to other age groups. Males were the most affected with 57.14% (24/92) compared to females. The ratio in terms of virus positivity and clinical manifestations evidenced diarrhea in 42/42 (100%), followed by vomiting 28/42 (73.80%). The present study indicates that adenoviruses 40 and 41 are important etiological agents for diarrhea in the child population studied.

Effect of endogenous hydrogen sulfide inhibition on structural and functional renal disturbances induced by gentamicin

Animal models of gentamicin nephrotoxicity present acute tubular necrosis associated with inflammation, which can contribute to intensify the renal damage. Hydrogen sulfide (H2S) is a signaling molecule involved in inflammation. We evaluated the effect of DL-propargylglycine (PAG), an inhibitor of endogenous H2S formation, on the renal damage induced by gentamicin. Male Wistar rats (N = 8) were injected with 40 mg/kg gentamicin (im) twice a day for 9 days, some of them also received PAG (N = 8, 10 mg·kg-1·day-1, ip). Control rats (N = 6) were treated with saline or PAG only (N = 4). Twenty-four-hour urine samples were collected one day after the end of these treatments, blood samples were collected, the animals were sacrificed, and the kidneys were removed for quantification of H2S formation and histological and immunohistochemical studies. Gentamicin-treated rats presented higher sodium and potassium fractional excretion, increased plasma creatinine [4.06 (3.00; 5.87) mg percent] and urea levels, a greater number of macrophages/monocytes, and a higher score for tubular interstitial lesions [3.50 (3.00; 4.00)] in the renal cortex. These changes were associated with increased H2S formation in the kidneys from gentamicin-treated rats (230.60 ± 38.62 µg·mg protein-1·h-1) compared to control (21.12 ± 1.63) and PAG (11.44 ± 3.08). Treatment with PAG reduced this increase (171.60 ± 18.34), the disturbances in plasma creatinine levels [2.20 (1.92; 4.60) mg percent], macrophage infiltration, and score for tubular interstitial lesions [2.00 (2.00; 3.00)]. However, PAG did not interfere with the increase in fractional sodium excretion provoked by gentamicin. The protective effect of PAG on gentamicin nephrotoxicity was related, at least in part, to decreased H2S formation.

Roles of mitogen-activated protein kinases and angiotensin II in renal development

Experimental and clinical evidence suggests that angiotensin II (AII) participates in renal development. Renal AII content is several-fold higher in newborn rats and mice than in adult animals. AII receptors are also expressed in higher amounts in the kidneys of newborn rats. The kidneys of fetuses whose mother received a type 1 AII receptor (AT1) antagonist during gestation present several morphological alterations. Mutations in genes that encode components of the renin-angiotensin system are associated with autosomal recessive renal tubular dysgenesis. Morphological changes were detected in the kidneys of 3-week-old angiotensin-deficient mice. Mitogen-activated protein kinases (MAPKs) are important mediators that transduce extracellular stimuli to intracellular responses. The MAPK family comprises three major subgroups, namely extracellular signal-regulated protein kinase (ERK), c-jun N-terminal kinases (JNK), and p38 MAPK (p38). Important events in renal growth during nephrogenesis such as cellular proliferation and differentiation accompanied by apoptosis on a large scale can be mediated by MAPK pathways. A decrease in glomerulus number was observed in embryos cultured for 48 and 120 h with ERK or p38 inhibitors. Many effects of AII are mediated by MAPK pathways. Treatment with losartan during lactation provoked changes in renal function and structure associated with alterations in AT1 and type 2 AII (AT2) receptors and p-JNK and p-p38 expression in the kidney. Several studies have shown that AII and MAPKs play an important role in renal development. However, the relationship between the effects of AII and MAPK activation on renal development is still unclear.

Uso de cantaridina en verrugas comunes y moluscos contagiosos: un estudio abierto / Use of cantaridine in common warts and contagious mollusca: an open study

Se realiza un estudio abierto, no randomizado, para evaluar la respuesta de cataridina en pacientes con verrugas comunes y pacientes con muluscos contagiosos. Se concluye que la cantaridina es eficaz y segura en el tratamiento de moluscos contagiosos, no así en el caso de verrugas comunes, en que logramos una respuesta pobre

Realimentación digestiva en pancreatitis aguda: ¿cuándo y cómo? / Digestive refeeding in acute pancreatitis: when and how?

Background: Digestive refeeding in acute pancreatitis represent a dificult issue. It requires the rsolution of intestinal ileus and carries a risk of reactivation. Aim: To evaluate criteria that may guide in early refeeding avoiding unnecesary prolonged fasting. Patients and methods : Thirty patients with acute pancreatitis were evaluated in a prospective trial. The severity of the pancreatitis was evaluated according to APACHE II score and Balthazar CT scan altertions. The criteria proposed to start early refeeding were abscence of nausea and vomiting, decreased abdominal pain, presence of bowel sounds and lowering of serum amylase levels. Balthazar CT scan clasification, was used to decide between oral or enteral refeeding. Results. Eighty percent of patients had alterations in pancreatic density, necrosis or pancretic or peripancreatic liquid collections in the CT scan (correspondig to Balthazar stages C,D,or E). Ten patients fullfilled the criteria for enteral refeeding at 8.1 ñ 3.5 days (range 3 to 15 days), and 21 patients fulfilled criteria fo enteral refeeding at 8.7ñ4.5 (range 4-19). No patient had a reactivation of his pancreatitis. Conclusions . Digestive refeeding can be done safely by using the criteria proposed in this study. Pancreatic necrosis or peripancreatic fluid collections do not contraindicate refeeding. Oral feeding may be employed (as the first option) in selected patients, without increasing the riskof complication, regardless of CT scan alterations of the pancreas

Infection by Trypanosoma cruzi in mammals in Yucatan, Mexico: a serological and parasitological study

Para determinar a infeccao pelo Trypanosoma cruzi em mamiferos em Yucatan, Mexico, foram estudados 372 animais selvagens e sinantropicos incluindo carnivoros, marsupiais e roedores. Estudos sorologicos pela hemaglutinacao indireta (IHA) foram realizados para detectar anticorpos contra o T. cruzi e estudos parasitologicos (esfregacos de sangue e histopatologia). De todos os animais testados 18,54 por cento foram sorologicamente positivos com frequencia significativamente maior entre os silvestres (33,3 por cento) em comparacao com os sinantropicos (11,79 por cento). Para determinacao do T. cruzi nos animais positivos, o sangue foi inoculado em camundongos brancos (tipo Webster) para provar a colonizacao miocardica. Atraves da sua positividade sorologica e parasitologica, bem como seu comportamento no meio ambiente acompanhado pelas caracteristicas sociais, economicas e culturais da populacao, deduz-se que em Yucatan, Mexico, Canis familiaris, Didelphis marsupialis e Rattus rattus atuam como ligacao com o ciclo selvagem

Gastrostomía percutánea endoscópica en lactantes con daño neurológico severo / Percutaneous endoscopic gastrostomy in infants with severe neurological impairment

La gastrostomía percutánea endoscópica (GEP) es una técnica para instalar una gastrostomía de alimentación sin necesidad de laparotomía ni anestesia general. Hemos efectuado dos de estos procedimientos en lactantes con daño neurológico severo, uno congénito y el otro secundario a hipoxia perinatal. Ambos procedimientos realizados en la sala de endoscopía, resultaron simples y rápidos (7 y 8 minutos) provocando mínimas molestias a los pacientes. Los lactantes llevan 7 y 4 meses alimentándose por esta nueva vía. No han presentado infección de la herida en torno a la sonda ni reflujo gastroesofágico de la papilla. Han mejorado notablemente su estado nutritivo y no han vuelto a presentar trastornos respiratorios. Creemos que la GPE es una técnica segura, simple y de bajo costo que permite la alimentación enteral por largos períodos en lactantes con daño neurológico severo

Hepatectomias. Nuestra experiencia en traumatismos hepaticos. / Hepatectomies. Our experience in hepatic trauma

Se presentan 15 casos de hepatectomias en una serie de 385 traumatismos hepaticos mencionando las vias de abordaje, la tactica y tecnica seguidas en base a los estudios actuales sobre segmentacion hepatica. La mortalidad fue del 53,33%