Eccema herpético por virus herpes simplex tipo 2: revisión de la literatura a propósito de un caso / Eczema herpeticum caused by herpes simplex virus type 2: review of the literature about one case

Eczema herpeticum is an extensive vesicular eruption caused by cutaneous dissemination of herpes simplex virus in patients who have underlying skin conditions or epidermal barrier disruption. Herpes simplex virus type 1 (HSV 1) is the most common etiology. This is the first report in Chile of a case of eczema herpeticum caused by HSV 2 in a patient with Darier' s disease, We review the literature and emphasize the use of sensitive and specific assays as real time polimerase chain reaction, that allow to initiate timely the correct treatment.

El eccema herpético es una erupción vesicular extensa causada por la diseminación cutánea del virus herpes simplex, en pacientes con trastornos cutáneos previos o daño de la barrera epidérmica. La etiología más frecuente es virus herpes simplex tipo 1 (VHS 1), aunque se han reportado casos de virus herpes simplex tipo 2 (VHS 2). Presentamos el primer reporte en Chile de eccema herpético por VHS 2 en un paciente con enfermedad de Darier. Realizamos una revisión de la literatura médica y destacamos la importancia del uso de técnicas sensibles y específicas como la reacción de polimerasa en cadena (RPC) en tiempo real, que posibilitan el inicio precoz de la terapéutica correcta.

Angiomixoma superficial preauricular: importancia médica / Preauricular superficial angiomyxoma: medical importance

Los angiomixomas superficiales son tumores benignos poco frecuentes y de presentación clínica variable. Se ubican de preferencia en tronco, extremidades y región de cabeza y cuello. El diagnóstico es histológico y relativamente fácil debido a las características propias de la lesión. El angiomixoma puede ser marcador de mixomas cardiacos y estar asociado simultáneamente con el síndrome o complejo de Carney, por lo que es importante siempre descartarlo. El tratamiento es la excisión quirúrgica, con alta probabilidad de recurrencia local, por lo que es fundamental el seguimiento post quirúrgico. A continuación presentamos el caso de un paciente de sexo masculino, de 60 años de edad, con un angiomixoma superficial preauricular, sin evidencia clínica ni imagenológica de componentes del complejo de Carney.

Superficial angiomyxoma are rare benign tumors with variable clinical presentations. They are located preferably in the trunk, limbs, and head and neck region. Histological diagnosis is relatively simple because there are specific features for this lesion. Superficial angiomyxomas may be a marker of cardiac myxomas and simultaneously be associated with Carney’s complex, so it is always important to consider this as a differential diagnosis. Treatment is surgical excision, with high probability of local recurrence, so post surgical follow-up is extremely important. We present the case of a male patient, 60 years old, with a preauricular superficial angiomyxoma with neither clinical nor radiological evidence of Carney’s complex components.

Manifestaciones purpúricas atípicas por parvovirus B19 en dos miembros de una familia: caso clínico / A family outbreak of parvovirus B19 atypical exanthemas: report of two cases

Two atypical cases of parvovirus B19 infection occurred consecutively within a family. A 14 year-old patient presented an extended papular-purpuric "gloves and socks" syndrome and two weeks later his mother developed a predominantly unilateral purpuric rash in the limbs with severe malaise. Specific IgM antibodies in the boy and polymerase chain reaction (PCR) and serology in the mother, confirmed parvovirus B19 infection. We emphasize the variable presentation of B19 infection within a family. The importance ofetiologic studies in the presence of atypical exanthemas and the utility of PCR in the diagnosis ofB19 are undesrscored.

Epidemiología clínica y molecular de las infecciones por Shigella spp en niños de la Región Metropolitana durante el verano 2004-2005 / Shigella spp Infections In children living In the Metropolitan RegionChile, during summer of 2004-2005

Background: Shigella spp is a frequent cause of diarrhea in children. Antimicrobials decrease the duration of diarrhea and pathogen excretion. However, the increasing resistance limits their therapeutic value. Aim: To study Shigella serotype distribution in the Metropolitan Region in Chile, and its relationship with severity of disease, antimicrobial resistance pattern and clonality. Material and methods: During summer 2004-2005, stool samples from children with diarrhea were collected in Cary Blair transpon medium and cultured. Shigella isolates were serotyped using monoclonal and polyclonal commercial antibodies. In vitro activity of ampicillin, amoxicillin/clavulanic acid, chloramphenicol, cotrimoxazol, nalidixic acid, ciprofloxacin, ceftriaxone and azythromycin was determined by minimal inhibitory concentration (MIC). Clonality was studied by pulsed-field gel electrophoresis (PFGE) using Xbal as restriction enzyme. Results: One hundred thirty nine Shigella strains were isolated (77 S sonnei and 62 S flexneri). S sonnei and S flexneri 2a serotypes were responsible for 95 percent of episodes. Children aged 2-4 years, showed a greater incidence of Shigella infections and 77 percent of episodes were treated on an ambulatory basis. High resistance levels were observed for ampicillin, cotrimoxazole, amoxicillin-clavulanic acid and chloramphenicol (67 percent, 60 percent, 56 percent and 45 percent, respectively). We found 11 resistance patterns and 61,2 percent of strains were multiresistant. There were multiple clones without a strict relationship with resistance patterns. Conclusions: Shigella infections in Metropolitan Region in Chile are associated to a restricted number of serotypes, representing a clonal expansion associated to different antimicrobial resistant patterns.

Brote de sarna en un hospital terciario a partir de un caso de sarna costrosa / An outbreak of scabies in a tertiary-care hospital from a crusted scabies case

Realizamos el estudio epidemiológico de un brote de sarna ocurrido en un hospital terciario, a partir de un caso de sarna costrosa, en febrero de 2005. Detectamos diez casos secundarios; ocho en el personal de salud y dos en pacientes hospitalizados, con una tasa de ataque de 4,1 por ciento. A diferencia de otros brotes, el diagnóstico de sarna costrosa se hizo al ingreso del caso primario al hospital. Las causas del brote fueron: adherencia deficiente a las medidas de aislamiento de contacto, permanencia prolongada del caso primario en sala compartida, y retardo en el inicio del tratamiento específico. Las principales medidas de control fueron: alertar a los servicios sobre el brote, realizar vigilancia epidemiológica, coordinación con la Dirección del Hospital y el Departamento de Salud Ocupacional, capacitar al personal de salud en las medidas de control, instaurar medidas de aislamiento y tratar a los casos y sus contactos con permetrina 5 por ciento loción tópica.

In February 2005 we performed an epidemiological study of an outbreak of scabies in a tertiary-care hospital which started from a crusted scabies case. We detected 10 secondary cases, 8 in healthcare workers and 2 in hospitalized patients. The attack rate was 4.1 percent. In contrast to previously described outbreaks, the crusted scabies case was recognized at admission. The outbreak causes were: lacking adherence to contact precautions, long stay of the primary case in the hospital ward and delay of specific treatment. The main control measures were: alerting the hospital services about the outbreak, performing epidemiologic surveillance, coordinating with the Hospital Direction and the Occupational Health Department, education of healthcare workers in control measures, implementation of isolation measures and treatment of cases and contacts with 5 percent permethrin topical lotion.