Eficacia y tolerancia de ciprofloxacina por 5 días en mujeres con infección urinaria: estudio multicéntrico / Efficacy and tolerance of a 5 days course of ciprofloxacin in the treatment of urinary tract infection in women

Background: There is no consensur about the ideal antimicrobial agent and duration of treatment for urinary tract infection in women. Aim: To assess the efficacy of a five days course of ciprofloxacion for the treatment of urinary tract infection in women. Patients and methods: Women with urinary tract infection were treated with ciprofloxacin (Baycip, Bayer) 250mg bid during 5 days. Patients were evaluated three to four days after treatment start, two to seven days and one month after treatment end. Results: Of 101 eligible women, 96 aged 18 to 65 years old, coming from three major Chilean cities, participated in the study and 80 completed the follow up period. There was a 95 percent clinical success, 2.5 percent partial improvement and 2.5 percent treatment failure. The causal microorganism was erradicated in 90 percent of cases, in 1.2 percent treatment failed and in 8.7 percent a re-infection occurred. Adverse effects attributable to the drug were observed in 12 patients (headache in 3, gastrointestinal disturbances in 8, somnolence in 1 and irritability in 1). Conclusions: Ciprofloxacin is an useful antimicrobial for the treatment of lower urinary tract infection in women

Infección por Chlamydia trachomatis en hombres chilenos asintomáticos y con uretritis: utilidad de la orina de primer chorro / Chlamydia trachomatis infection in asymtomatic men with urethritis: usefulness of first catch urine samples

Background: Chlamydia trachomatis is responsible for 30 to 50 percent of genital tract infections and is present, without symptoms, in 20 percent of men and 60 percent of women. We have little information in Chile about the prevalence of ths infection. Aim: to assess the prevalence of Chlamydia trachomatis in men, using first catch urine samples. Subjects and methods: three hundred and fifty one first catch urine samples of asymptomatic men and 50 samples coming from men with a primary urethritis, were analyzed. Urethral discharge samples from the latter were simultaneously studied. Analysis was performed using an enzyme immunoanalysis (MicroTrak Chlamydia EIA, Syva Co.) and a nested polymerase chain reaction towards the gene that codifies MOMP (PCR/OMP). Results: amoung asymptomatic men, two of 154 teenagers aged 18 to 19 years old (1.3 percent), 10 of 100 university students (10 percent) and eight of 97 adults over 30 years old (8.2 percent), were infected. The global prevalence of infection in these men was 5.7 percent. The prevalence of infection i men with urethritis was 12 percent. Urine EIA had a higher detection frequency than PCR/OMP, but according to another PCR assay, these results were false positives. EIA in first catch urine, had a sensitivity, specificity, positive and negative predictive value of 83.3, 75, 31.3 and 97 percent respectively, for the detection of Chlamydia trachomatis. The figures for PCR/OMP were 100 percent for all these parameters. Conclusions: the prevalence of Chlamydia trachomatis infection in Chilean men is similar to that reported in developed countries. Enzyme immuno assay in first catch urine had a good diagnostic accuracy and could be used in epidemiological studies in asymptomatic men

Variación temporal de genotipos y serogrupos de E coli enterohemorrágicos aislados en niños chilenos con infecciones intestinales o síndrome hemolítico urémico / Temporal variation of genotypes and serogroups of enterohemorrhagic E coli isolated from chilean children with intestinal infections or hemolytic-uremic syndrome

Thirty six strains isolated from chilean children with hemolytic-uremic syndrome (8 obtained in 1988-1989, 15 obtained in 1990-1993 and 13 obtained in 1995-1996), 33 strains from asymptomatic children, obtained in similar periods and 30 strains from children with bloody diarrhea, obtained in 1995-1996 were studied. Virulence factors were investigated with a colony hybridization technique using probes that identify virulence genes. Serotypes were identified with commercial antisera. Both SLTI and SLTII genes predominated in strains obtained from children with hemolytic uremic syndrome in 1988-1989 and 1995-1996 and SLTI gene predominated in strains obtained in 1990-1993. Similar temporal variations in virulence genes of strains obtained from asymptomatic children were observed. SLTI/SLTII pattern predominated in strains obtained from children bloody diarrhea and the frequency of 0157 serogroup was lower, compared to strains obtained from children with hemolytic uremic syndrome. There was a temporal variation in toxigenic genotypes of enterohemorrhagic E coli strains, but no association between these genotypes and the risk for hemolitic uremic syndrome was observed

Relaciones fenotípicas y moleculares entre cepas de vibrio cholerae 01 aisladas en Chile, Perú y Bolivia: comparación con cepas de reservorios ambientales / Phenotypical and molecular relation between vibrio cholerae 01 strains, isolated in Chile, Perú and Bolivia: comparison with strains from environmental reservoirs

The phenotype, biotype and susceptibility to nine antimicrobials was determined for each isolated strain. Also, the genes of cholera and termolabile toxins were determined using DNA probes and a chromosomal restriction profile was done using HindIII, EcoRI and NotI enzymes. Features studied were similar in the 53 strains isolated from patients. Those isolated from environmental reservoirs had different antimicrobial susceptibility, showing ampicillin resistance and the GT gene was detected in one of 20 strains, compared to clinical samples were it was present in all. Strains isolated from patients and envirinment had similar chromosomal restriction profiles. The chromosomal restriction profile gives an image of bacterial genome and it is a useful and reliable tool for the epidemiological surveillance of cholera

Susceptibilidad in vitro de escherichia coli enterohemorrágicas frente a 11 antimicrobianos: relación entre resistencia antibiótica y genotipos toxigénicos / In vitro susceptibility of enterohemorrhagic escherichia coli to 11 antimicrobials: relation between antibiotical resistance and toxicogenic genotypes

Enterohemorrhagic escherichia coli (EHEC) has been recognized as the main etiologic agent of hemorrhagic colitis and hemolytic uremic syndrome (HUS). The usefulness of antibiotic treatment in patients with EHRC infections is a matter of current debate. Knowledge on EHEC antimicrobial susceptibility patterns in different geographic areas is important for both treatment considerations and for strain characterization. We studied by diffusion disk agar technique the antibiotic susceptibility of 83 EHEC strains obtained from stools of patients with HUS or diarrhea. Eleven antimicrobials were tested (ampicillin, cotrimoxazole, tetracycline, chloramphenicol, furazolidone, gentamycin, amikacin, ciprofloxacin, erythromycin, vancomycin and metronidazol). Resistant strains by disk diffusion were tested for MIC (mg/ml) by agar dilution. SLT-I and SLT-II were detected with specific biotinylated gene probes. All 83 strains were susceptible to furazolidone, ciprofloxacin, gentamycin and amikacin. Resistance was detected to tetracycline 4 percent, chloramphenicol 5 percent, cotrimoxazole 24 percent and ampicillin 25 percent. As expected for EHEC strains all were resistant to erythromycin, vancomycin and metronidazol. Resistant strains were significantly more common in non toxigenic and SLT-I producing strains (p=0.01). Resistant strains were similarly distributed among patients who had diarrhea only and those who developed HUS (p=0.3). In Chile, resistant EHEC strains seem to be more common and of different genotypes than those reported in more developed countries. Regional differences of EHEC antibiotic susceptibility patterns indicate a need for continious monitoring, specially if antibiotic prove to be useful in disease prevention

Escherichia coli enterohemorrágica en el síndrome hemolítico urémico, en niños chilenos: evaluación de diferentes técnicas de diagnóstico de infección / Enterohemorrhagic escherichia coli in hemolytic uremic syndrome, in chilean children: evaluation of different technics of infection diagnosis

Enterohemorrhagic escherichia coli (EHEC), have been associated with pathogenesis of hemolytic uremic syndrome (HUS) worldwide. Our aim was to determine the association of EHEC ing¿fection and HUS in chilean children. During may 1991 and october 1993, 34 children HUS and 33 age matched controls (children with diarrhea that did not develop HUS) were enrolled in a case/control study. For each child a stool and serum sample were obtained at admission. Stools were processed for common enteropathogen and for EHEC identification. EHEC were identified in stools by gene probes for different virulence factors (EHEC plasmid-associated fimbria, Shiga-like toxin I, Shiga-like toxin II and eae adherence factor) and by detection of free fecal toxin by neutralization assay in Vero cells. Sera were processed for anti-cytotoxin antibodies also by an assay in Vero cells. Enteropathogens were isolated in 20.6 percent and 15.5 percent of HUS and control children respectively (p=NS). 91 percent of the HUS children and 73 percent of the control children were EHEC positive by one or more of the techniques used (p=0.05). Of the 3 detection methods used for EHEC, only free fecal cytotoxin was significantly more common in HUS children than controls (45.5 percent vs 9 percent p=0.007). Genotype patterns of HUS and controls strains were similar except for a trend towards a higher frequency of non-toxigenic strains in the control group. Serogroup 0157 was more common in HUS children than in controls (9 percent vs 0 percent p=0.036). In Chile as in other countries, EHEC infection is common and significantly associated with occurrence of HUS. Infection with EHEC strains 0157 seems to be important risk factor for HUS

Campylobacter pylori en niños y adultos sometidos a endoscopia: correlación de hallazgos endoscópicos, bacteriológicos e histopatológicos / Campylobacter pylori in gastric mucosa of children and adults: correlation of endoscopic, hystologic and bacteriologic findings

Campylobacter pylori has been associated to peptic ulcer and gastritis. We investigated the presence of C pylory in 17 children and 50 adults who needed endoscopy to investigate upper gastrointestinal symptoms. Gram stain, Wartin-Starry stain and the urease test were used to identify the germ; best results were obtained with the Gram stain. C pylori was present in 5.8% of children and 88% of adults, incluinding al patientes with peptic ulcer and 36 out of 30 with hystologic evidence of gastritis. However, the germ was also found in 79% of patients with a normal mucosa. Our results suggest that C pylori is frequently present in gastric mucosa of children and adults with upper gastrointestinal problems. Further studies are needed to elucidate its possible pathogenic role in gastritis or peptic ulcer