Primera identificación en Ecuador de Comamonas kerstersii como agente infeccioso / First identification in Ecuador of Comamonas kerstersii as an infectious agent

Resumen Comunicamos la primera identificación en Ecuador del microorganismo Comamonas kerstersii, cepa aislada a partir de una muestra de líquido de la cavidad abdominal e identificada mediante la técnica de espectrometría de masas MALDITOF. Fue obtenida durante el acto quirúrgico de un paciente con el diagnóstico de una peritonitis aguda, secundaria a una apendicitis perforada. Este microorganismo es considerado un patógeno poco común. Pese a que el género al que pertenece tiene una amplia distribución geográfica, es considerado un agente oportunista.

Abstract We report the first identification in Ecuador of the microorganism Comamonas kerstersii, a strain isolates from a sample of fluid from the abdominal cavity and identified by the technique of mass spectrometry MALDITOF. It was obtained during the surgical act of a patient with the diagnosis of acute peritonitis, secondary to a perforated appendicitis. This microorganism is considered a rare pathogen. Even though the genus to which it belongs has a wide geographical distribution, this pathogen is considered an opportunistic agent.

Primer reporte de Cryptococcus gattii en Ecuador / First report of Cryptococcus gattii in Ecuador

El presente es el reporte de un caso de un paciente masculino de 37 años, con manifestaciones clínicas de aproximadamente 1 año de evolución caracterizadas por cefalea holocraneana de gran intensidad, fotofobia, diplopía, que se exacerban en los últimos tres meses con alucinaciones, pérdida de audición de oído izquierdo, refirió exposición de 4 años a heces de aves (palomas) por su trabajo en el puerto marítimo.Acudió por consulta privada a valoración y manejo, se le efectúa el diagnóstico de diabetes mellitus tipo 2, por lo cual se prescribió metformina oral, una vez iniciado el tratamiento presentó exacerbación de los síntomas neurológicos, por lo que se indicó internación hospitalaria y se sometió a investigación para diagnóstico de su enfermedad, con presunción de meningitis bacteriana, se le realizó punción lumbar para estudios microbiológicos y se inició tratamiento empírico con glucopeptido y carbapenemico. Con el esquema antimicrobiano presentó leve mejoría en la intensidad de sus síntomas, en el estudio microbiológico del líquido cefalorraquídeo se observaron estructuras micóticas compatibles con Cryptococcus, por lo cual se realizó una segunda punción lumbar para conseguir una muestra adecuada para cultivo y estudio con biología molecular, a fin de establecer el diagnóstico definitivo del microorganismo.

The present is a report of a 37-year-old male patient, who present clinical manifestations of approximately 1 year, by high-intensity holocranial headache, photophobia, diplopia, which were exacerbated in the last three months with hallucinations, loss of Hearing from the left ear, hereported exposure of 4 years to feces of birds (pigeons) for his work in the seaport.The patient was refer to a private consultation to assessment and management, he was diagnosed with type 2 diabetes mellitus, for which oral metformin was prescribed, once the treatment had begun, exacerbation of the neurological symptoms, so hospitalization was indicated, and He underwent research to diagnose his disease, with presumed bacterial meningitis, he underwent lumbar puncture for microbiological studies and began empirical treatment with glucopeptide and carbapenemic; With the antimicrobial scheme, there was a slight improvement in the intensity of its symptoms. In the microbiological study of the preliminary cerebrospinal fluid, fungal structures compatible with Cryptococcus were observe; a second lumbar puncture was performed to obtain an adequate sample for culture and study with molecular biology, in order to establish the definitive diagnosis of the microorganism.

Toxoplasmosis cerebral en paciente VIH / Cerebral toxoplasmosis in HIV patient

The epidemic associated with infection by human immunodeficiency virus (HIV) is one of the main health problems in the world, about one million people died as a result of infection related to it; according to the statistical data of 2016 the number of infected persons was 36,7 million, 34,5 million were adults and 2,1 million children (under 15 years), it was calculated for 2016 that there were about 1,8 million of new HIV infections.Toxoplasma encephalitis (ET) is a zoonosis of global distribution is one of the most frequent opportunistic diseases in patients with immunosuppression by HIV. Toxoplasma gondii is a protozoan, which infects the human being through the intake of raw or undercooked meat. The following is the report of a case of a 25-year-old patient with a recent diagnosis of HIV infection, who went to the emergency room for generalized headache of moderate intensity, which did not yield to the administration of medications, was accompanied by drowsiness, paresthesia of the tongue and left hemicara.

The epidemic associated with infection by human immunodeficiency virus (HIV) is one of the main health problems in the world, about one million people died as a result of infection related to it; according to the statistical data of 2016 the number of infected persons was 36,7 million, 34,5 million were adults and 2,1 million children (under 15 years), it was calculated for 2016 that there were about 1,8 million of new HIV infections.Toxoplasma encephalitis (ET) is a zoonosis of global distribution is one of the most frequent opportunistic diseases in patients with immunosuppression by HIV. Toxoplasma gondii is a protozoan, which infects the human being through the intake of raw or undercooked meat. The following is the report of a case of a 25-year-old patient with a recent diagnosis of HIV infection, who went to the emergency room for generalized headache of moderate intensity, which did not yield to the administration of medications, was accompanied by drowsiness, paresthesia of the tongue and left hemicara

Histoplasmosis diseminada en paciente con infección por VIH / Disseminated Histoplasmosis in a patient with infection

La Histoplasmosis es una infección micóticaoportunista, frecuente en pacientes con infección por virus de inmunodeficiencia humana (VIH) y síndrome de inmunodeficiencia adquirida (SIDA). La mayoría de las veces suele ser asintomática, pudiendo asociarse a hemorragia, destrucción acelerada de las plaquetas y descenso de la hemopoyesis debido a infección de los megacariocitos. Este reporte trata de un paciente con diagnóstico reciente de infección por VIH, por cuadro de 1 mes de evolución caracterizado por fiebre, malestar general y pérdida de peso mayor a 10% de la masa ponderal. Durante su hospitalización se realizaron estudios de imágenes y laboratorio para tamizaje de infecciones oportunistas. La evolución clínica inicialmente estuvo marcada por deterioro progresivo del estado general, con alteraciones persistentes de las plaquetas y de la serie eritroide, por lo que fue evaluado por el servicio de Hematología, que realizó la punción biopsia por aspiración de médula ósea (BAMO) para descartar malignidad hematológica y compromiso medular por agentes oportunistas.

Histoplasmosisis an opportunistic fungal infection, frequent in patients with infection by human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). Most of the time it is usually asymptomatic, and it can be associated with hemorrhage, the accelerated destruction of platelets and the decrease in hemopoiesis due to an infection of megakaryocytes. This report is based on a recent diagnosis of HIV infection, in a picture of evolution of fever, malaise and weight loss greater than 10% of body weight.During his hospitalization, imaging and laboratory studies are carried out to screen for opportunistic infections. Clinical evolution remained marked by progressive general state, with persistent alterations of platelets and erythroid series, so it was evaluated by the hematology service, which performed the bone marrow aspiration biopsy (BAMO) to rule out Hematological malignancy and spinal commitment by opportunistic agents.

Propuesta algoritmo de cribado para alteraciones morfológicas de la Próstata. Revisión de la evidencia actual / Proposed screening algorithm for morphological alterations of the Prostate. Review of current evidence

Las alteraciones morfológicas de la próstata, por las que se realiza cribado son la hiperplasia prostática benigna (HPB) y el cáncer de próstata (CaP). La HPB es el tumor benigno más frecuente en varones mayores de 50 años, se caracteriza por el aumento del volumen de la glándula y usualmente acompañado de síntomas urinarios. El CaP es la segunda causa de muerte relacionada con cáncer en Estados Unidos y Europa en mayores de 70 años, su incidencia por debajo de los 50 es rara. El cribado o pruebas de detección, tiene como meta el hallar el cáncer antes de la aparición de síntomas, el cribado no se realiza en pacientes por sospechar que tienen cáncer, sino como un método de pesquisa. El objetivo de este artículo, es efectuar una revisión a los referentes teóricos, y proponer un nuevo algoritmo diagnóstico de alteraciones morfológicas de la próstata, basado en la evidencia.

Morphological alterations of the prostate, for which screening is performed include benign prostatic hyperplasia (BPH) and prostate cancer (PCa). BPH is the most common in men over 50 years benign tumor, is characterized by the increase in the volume of the gland and usually accompanied by urinary symptoms. PCa is the second leading cause of cancer-related death in the United States and Europe in over 70 years, the incidence below 50 is rare. Screening or testing, aims the finding cancer before the onset of symptoms, screening is not performed in patients with suspected cancer, but as a method of investigation. The purpose of this article is to review the theoretical framework and propose a new diagnostic algorithm of morphological alterations of the prostate, based on evidence.

Tuberculosis extrapulmonar en paciente inmunocompetente / Extrapulmonary tuberculosis in immunocompetent patient

La tuberculosis extrapulmonar se define como la infección ocasionada por Mycobacterium tuberculosis a tejidos y órganos fuera del parénquima pulmonar, aproximadamente el 1-3 % del total de los casos de TB son extrapulmonares y de estos el 11-16 % afectan al abdomen; 10 al 15 % en los no infectados por el VIH y hasta en 70 % en los infectados. El presente reporte es acerca de una paciente de 34 años, sexo femenino, heterosexual, que no refirió conductas sexuales de riesgo, misma que solicitó valoración por emergencias del hospital general del norte de Guayaquil Los Ceibos (HGNG-C), refiriendo manifestaciones clínicas de 1 semana de evolución aproximadamente, tales como: náusea, vómitos, deposiciones líquidas en varias ocasiones, sin mejoría a pesar de tratamiento médico previo, que se complica con la aparición de dolor abdominal severo, por el cual se decidió efectuar apendicetomía de emergencia; en los resultados anatomopatológicos se detectaron estructuras granulomatosas, estableciéndose el diagnóstico de tuberculosis extrapulmonar.

Extrapulmonary tuberculosis is defined as the infection caused by Mycobacterium tuberculosis to tissues and organs outside the lung parenchyma, approximately 1-3 % of the total TB cases are extrapulmonary and of these 11-16 % affect the abdomen; 10 to 15 % in those not infected by HIV and up to 70 % in those infected. The present report is about a 34-year-old female,heterosexual, who did not report risky sexual behavior, who requested emergency assessment from the general hospital in the north of Guayaquil Los Ceibos (HGNG-C), referring to manifestations clinics of 1 week of evolution, such as: nausea, vomiting, liquid stools on several occasions, without improvement despite previous medical treatment, which is complicated by the appearance of severe abdominal pain, for which it was decided to perform emergency appendectomy ; In the anatomopathological results, granulomatous structures were detected, establishing the diagnosis of extrapulmonary tuberculosis.