ABSTRACT
Las infecciones por levaduras del género Cryptococcus pueden causar un abanico amplio de manifestaciones clínicas, dependiendo de si se trata de una infección invasora o no. Los pacientes susceptibles, especialmente de las formas invasoras, comparten el compromiso de la inmunidad celular, ya sea por afecciones primarias o secundarias. El grupo más estudiado es el de personas que viven con VIH. La mortalidad es alta, especialmente en entornos de recursos reducidos. El esquema de tratamiento es en fases, inicialmente combinado, para luego continuar con monoterapia por un periodo prolongado, dependiendo de la duración del factor de riesgo subyacente. Hacemos una revisión de la evidencia y recomendaciones actualizadas.
Infection by yeast of the Cryptococcus genus can cause a wide range of clinical manifestations, depending on whether it is an invasive infection or not. Susceptible patients, especially those with invasive forms, share the compromise of cellular immunity, either due to primary or secondary conditions. The most studied group is that of people living with HIV. Mortality is high, especially in resource-poor settings. The treatment scheme is in phases, initially combined, to then continue with monotherapy for a prolonged period, depending on the duration of the underlying risk factor. We review the evidence and update recommendations.
ABSTRACT
Resumen La toxoplasmosis es una de las parasitosis con mayor prevalencia en el mundo. Se asocia a morbimortalidad perinatal y en población inmunocomprometida. Actualmente se cuenta con varias pruebas diagnósticas, tanto serológicas como moleculares, que pueden ayudar a confirmar el diagnóstico y diferenciar una infección reciente de una pasada. Proponemos algunas recomendaciones para el diagnóstico y tratamiento de la toxoplasmosis en distintos escenarios clínicos basados en la evidencia actualmente disponible.
Abstract Toxoplasmosis is one of the most prevalent parasitosis in the world. It is associated with perinatal morbidity and in immunocompromised population. Currently, there are several diagnostic tests, both serological and molecular, that can help confirm the diagnosis and differentiate a recent infection of a pass. We propose some recommendations for the diagnosis and treatment of toxoplasmosis in different clinical scenarios based on the currently available evidence.
Subject(s)
Humans , Toxoplasma , Toxoplasmosis/diagnosis , Toxoplasmosis/drug therapy , Antibodies, Protozoan , Immunocompromised HostABSTRACT
Las mujeres embarazadas o en período de lactancia han sido excluidas de los ensayos clínicos sobre vacunas contra SARS-CoV-2, evitando así la obtención de datos sólidos que permitan determinar la seguridad e inmunogenicidad de las vacunas en esta población, a la vez que se han asociado peores resultados maternos fetales. La evidencia acerca de la seguridad e inmunogenicidad en esta población es limitada, en base a estudios observacionales, con pocos casos y en mujeres vacunadas con plataformas ARNm, en las cuales no se ha descrito por ahora una mayor asociación a eventos adversos relacionados a vacunas, como tampoco, variaciones significativas en la respuesta inmunológica en comparación a la población no embarazada. También existen datos que documentan la adquisición de anticuerpos transplacentarios, considerándose de bajo riesgo la posibilidad de transmisión vertical. Se hacen necesarios ensayos clínicos que permitan precisar recomendaciones basadas en evidencia para esta población, en un contexto de utilización de emergencia de vacunas contra SARS-CoV-2. (AU)
Pregnant or breastfeeding women have been excluded from clinical trials on vaccines against SARSCoV-2, thus avoiding obtaining solid data to determine the safety and immunogenicity of vaccines in this population, as well as being associated worse maternal-fetal outcomes. The evidence about safety and immunogenicity in this population is limited, based on observational studies, with few cases and in women vaccinated with mRNA platforms, in which a greater association to adverse events related to vaccines has not been described or significant variations in the immune response compared to the non-pregnant population. There are also data that document the acquisition of transplacental antibodies, considering the possibility of vertical transmission as low risk. Clinical trials are necessary to evidence-based recommendations for this population, in a context of emergency use of vaccines against SARSCoV-2. (AU)
Subject(s)
Humans , Female , Pregnancy , Breast Feeding , Pregnancy/immunology , COVID-19 Vaccines/adverse effects , Infectious Disease Transmission, Vertical/prevention & control , COVID-19/prevention & control , COVID-19/transmissionABSTRACT
Se describe hasta la fecha de hoy, 4 de julio del 2021, la evidencia existente sobre la variante Delta del SARS-CoV-2, su impacto en la trasmisión, en la severidad de la infección y su probable evasión a la respuesta inmune. (AU)
As of today, July 4, 2021, the existing evidence on the Delta variant of SARS-CoV-2, its impact on transmission, on the severity of the infection and its probable evasion of the immune response is described. (AU)
Subject(s)
Humans , RNA/genetics , COVID-19/genetics , Mutation/genetics , Chile/epidemiology , Mass Vaccination , Immune Evasion , COVID-19/transmission , COVID-19/epidemiologyABSTRACT
Background: Three-drug antiretroviral therapy (ART-3) has reduced complications and improved survival in HIV+ patients. The Chilean Public Health System began dual therapy (ART-2) in 1997, covering approximately 40 percent of patients in need. Aim: To report the results of a follow-up of patients with and without access to ART in a Chilean public hospital. Patient and Methods: Prospective follow-up of patients with ART-2 and 3 (cases) and patients with no access to ART (controls). All patients needed ART but it was available to a minority of them. Selection for ART was at random. Follow-up was between 6-24 months (11/96 to 3/99). Basal and periodic clinical and laboratory parameters were determined. Mortality and occurrence of new AIDS-defining events (ADE) were compared statistically using chi square. Results: One hundred and fifty cases (106 ART2, 28 ART3 and 16 ART2 expanded to ART3) and 166 controls were studied. Basal parameters were similar except prior ART (32.7 and 18.7 percent in cases and controls respectively). Close to 1/3 patients had AIDS. Cases had a mean follow up of 527 days; controls, 478. Six cases (4 percent) (5 in ART-2) and 17 controls (10 percent) died. Mortality x 100/pts/yr was 2.7 in cases and 7.7 in controls, p <0.05. ADE per 100/pts/yr was 21 in cases (24.4 in ART2, 15.1 in TAR3) and 54.5 in controls, p <0.05. Cases had a reduction of: esophageal candidiasis (84 percent), tuberculosis (75 percent), cryptococcosis and toxoplasmosis (66 percent), P carinii pneumonia (55 percent) and bacterial pneumonia (46 percent) and they had fewer hospitalizations (73 percent). Late assessment: 70 of 101 ART-2 patients had changed to ART-3 (1 death); 22 of 101 kept original ART-2 (12 dead, 10 alive), 39 of 43 ART-3 patients were alive and 1 died. Conclusions: Short-term ART-2 and 3 significantly reduced mortality (60 percent and 73 percent) ADE (65 percent and 76 percent respectively) and hospitalizations. Benefits of ART-2 were short lived. Resource-constrained countries cannot depend on weaker than standard ART for proper care of people with HIV disease
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Zidovudine , Lamivudine , Acquired Immunodeficiency Syndrome/drug therapy , Case-Control Studies , Prospective Studies , AIDS-Related Opportunistic Infections , Anti-HIV Agents , Hospitalization , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/mortalityABSTRACT
Agente: Bacillus anthracis. (Bacilo Gram positivo, aerobio estricto, esporulado, inmóvil). Reservorio: Herbívoros y sus subproductos, ambiente contaminado con esporas. Transmisión: Pasto con esporas ingestión por ganado esporas en carne, subproductos o suelo humano: contacto con piel, epitelio respiratorio, bucofaríngeo o intestinal. Laboratorio: Gram y cultivo en agar sangre de tejidos o líquidos infectados. Prevención: Vacuna y antimicrobianos Tratamiento: Penicilina V oral o g endovenosa, por un plazo variable de al menos 7 a 10 días. Alternativas: eritromicina, cloranfenicol, tetraciclina y ciprofloxacina
Subject(s)
Humans , Animals , Carbuncle/etiology , Bacillus anthracis , Carbuncle/diagnosis , Carbuncle/drug therapy , Carbuncle/transmission , Bacillus anthracis , Bacterial Vaccines , Chile , Disease Reservoirs , Occupational Risks , Penicillin G , Penicillin VSubject(s)
Humans , Flavivirus/pathogenicity , Yellow Fever/etiology , Aedes/pathogenicity , Aedes/virology , Chile/epidemiology , Disease Reservoirs , Flavivirus/isolation & purification , Insect Bites and Stings/diagnosis , Insect Bites and Stings/epidemiology , Insect Bites and Stings/prevention & control , Signs and Symptoms , Yellow Fever/diagnosis , Yellow Fever/epidemiology , Yellow Fever/prevention & controlABSTRACT
Background: Combined antiretroviral therapy (AVR) has shown a protective effect (PE) on morbidity and survival in HIV (+) patients of industrialised countries where triple-drug therapy (ARV-3) is standard. In Chile the public health system began providing double-drug therapy in 1997 (ARV-2) with 2 reverse transcriptase inhibitors. Aim: To assess the impact of ARV in morbimortality of HIV (+) patients in Chile after a year of follow up. Patients and methods: Retrospective case-control (1:1) study. Cases were 97 patients followed during 1997 for 6 or more months and dying during that period. Each case had a control of the same gender and CDC stage, similar age and CD4 count, but surviving a same period of follow up. A comparison of ARV before and during follow up (rate and type) was done. P carinii prophylaxis, pneumococcal immunization at baseline or follow up, frequency of hospital admissions and occurrence of opportunistic infections in both groups were assessed. Odds ratio (OR) for mortality, hospitalisation and opportunistic infections in ARV user, as well as treatment PE were calculated. Results: Twenty four (24.7 percent) cases and sixty six (68 percent) controls received ARV during follow up (p< 0.001), OR was 0.15 (CI 95 percent 0.08-0.3), p < 0.001, the PE was 6.6 for ARV users versus non users, among cases 19 patients received ARV-2 and five received ARV-3. Among controls, 41 patients received ARV-2 and 25 received ARV-3. These differences established an OR of 0.20 (CI 95 percent 0.09-0.04) and a PE of 5 for ARV-2 versus no ARV. For ARV-3 compared with no ARV the OR was 0.08 (CI 95 percent 0.003-0.26), and the PE 12.5. Fifty three (54.6 percent) cases and 13 (13.4 percent) controls required hospital admission, OR 0.49 (CI 95 percent 0.25-0.94), p=0.03, and PE of 2.04 of ARV versus no ARV; 82 (85.3 percent) cases and 50 (51 percent) controls had opportunistic infections, OR 0.5 (CI 95 percent 0.26-0.96), p=0.03 and PE of 2 for ARV versus no ARV. There were no significant differences in prior ARV, prophylaxis and immunisation between cases and controls. Conclusions: This study showed the high impact of ARV in short term morbimortality of HIV(+) patients and the need to implement antiretroviral therapy to all patients as an official health policy. This study did not answer the question of the role, if any, of weaker-than standard antiretroviral therapy
Subject(s)
Humans , Female , Male , Adult , Middle Aged , Protease Inhibitors/pharmacology , Zidovudine/pharmacology , Reverse Transcriptase Inhibitors/pharmacology , Acquired Immunodeficiency Syndrome/drug therapy , Case-Control Studies , Retrospective Studies , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/epidemiology , Anti-HIV Agents/pharmacology , Drug Therapy, Combination , Hospitalization/statistics & numerical data , Acquired Immunodeficiency Syndrome/mortalityABSTRACT
Los objetivos del tratamiento antiinfeccioso de la sífilis son controlar la enfermedad precoz, evitar su progresión y prevenir la transmisión horizontal y vertical. Penicilina sigue siendo el tratamiento de elección para la sífilis. Se revisan los esquemas recomendados actualmente para las diferentes etapas clínicas. Los esquemas alternativos con tetraciclinas, eritromicina, azitromicina y cefalosporinas de tercera generación requieren de plazos prolongados de tratamiento que amenazan su cabal cumplimiento o adolecen de ineficacia en algunas condiciones que se detallan
Subject(s)
Humans , Penicillin G Benzathine/pharmacology , Syphilis/drug therapy , Drug Administration Schedule , Natural History of Diseases , Neurosyphilis/cerebrospinal fluid , Penicillin G Benzathine/administration & dosage , Syphilis/diagnosis , Syphilis/etiology , Syphilis/prevention & control , Treponema pallidum/drug effects , Treponema pallidum/isolation & purification , Treponema pallidum/pathogenicitySubject(s)
Humans , Female , Pregnancy , Adult , Infant, Newborn , Malaria/diagnosis , Pregnancy Complications, Infectious/diagnosis , Malaria, Cerebral/etiology , Malaria, Falciparum , Malaria/complications , Malaria/drug therapy , Malaria/etiology , Plasmodium falciparum/drug effects , Plasmodium falciparum/pathogenicity , Pregnancy Complications, Infectious/drug therapy , Quinine/therapeutic useABSTRACT
El objetivo de este trabajo fue estudiar las características clínicas del embarazo con infección por virus de inmunodeficiencia humana (VIH) y la transmisión vertical. Se analizaron embarazadas con esta infección, controladas en la Fundación Arriarán, cuya gestación y parto fueron atendidos en la Maternidad del Hospital San Borja Arriarán. Durante la gestación se hizo pesquisa de otras infecciones. La zidovudina (AZT) fue usada según protocolo ACTG 076 en 6 mujeres. En el parto se prefirió la cesárea electiva. Se impidió la lactancia. Se hizo seguimiento de los niños. Diecisiete mujeres tuvieron 19 partos. Presentaron infección genitourinaria 4 pacientes (21,1 por ciento); infecciones no ginecológicas 5 (26,3 por ciento); patología del embarazo 4 (21,1 por ciento); rotura prematura de membranas de término 1 (5,3 por ciento); parto prematuro 3 (15,8 por ciento). El parto fue por cesárea en 15 casos (78,9 por ciento). La transmisión vertical fue 26,3 por ciento (5/19), 33,3 por ciento (5/15) en la cesárea y 16,7 por ciento con tratamiento de AZT. Un niño presentó muerte fetal y trece (68,4 por ciento) están sanos. Ocho mujeres están asintomáticas, tres sintomáticas, cuatro abandonaron controles y dos fallecieron. Es conveniente que la embarazada con infección por VIH use AZT y sea controlada por especialistas para disminuir los factores de riesgo en la transmisión vertical. La cesárea facilita la administración de AZT durante el parto. La lactancia materna debe suprimiese