Virus Zika: epidemiología, manifestaciones clínicas y prevención / Zika virus: epidemiology, clinical manifestations and prevention

Zika virus is an arbovirus that was first discovered in Africa in 1947. Until some time ago, it was an unnoticed emergent virus, due to its low epidemiological impact and its mild flu-like symptoms. However, from 2007 on, Zika virus started to propagate throughout the world and was first locally transmitted in America in 2015. Since then, autochthonous cases of Zika infection have been reported on 33 countries of the Americas. The most relevant impact of the Zika virus outspread is its supposed link to the increase in birth defects and microcephaly in newborns in regions with high Zika virus infection incidence during the past two years. Therefore, the World Health Organization declared Zika virus a public health emergency of international concern. This review describes Zika virus epidemiology, transmission mechanisms and pathogeny, such as its clinical presentation, adverse fetal outcomes, diagnosis, treatment and current recommendations for transmission prevention.

Endocarditis infecciosa por Aerococcus species: caso clínico y revisión de la literatura / Bacterial endocarditis caused by Aerococcus species: case report and literature review

Introducción: Aeroccus species es una bacteria Gram positiva considerada como un agente inusual de infecciones del tracto urinario y de endocarditis infecciosa. Clásicamente los adultos mayores varones con anomalías genitourinarias crónicas están expuestos a esta infección. Presentación del caso: Hombre de 55 años consulta por un cuadro de dos meses de evolución caracterizado por compromiso del estado general, fiebre continua, diaforesis, dolor torácico sordo lateralizado a izquierda, y baja de peso de 8 kg en un mes, con anorexia. Sin antecedentes mórbidos salvo estenosis uretral crónica con requerimiento de dilataciones transureterales, las cuales realiza con termómetro de mercurio. Paciente ingresa en regulares condiciones generales, quejumbroso. Examen pulmonar con disminución del murmullo pulmonar en la base izquierda más broncofonía. Tacto rectal doloroso a la palpación. Los exámenes complementarios revelan: hemograma con leucocitosis de 13.100/mm3, VHS de 63 mm/h, PCR de 21 mg/dL. En el estudio de fiebre de origen desconocido se realiza ecocardiografía transtorácica la que reveló vegetación en velo coronario izquierdo de 0,9 cm x 1 cm. Los hemocultivos resultan positivos para Aerococcus species sensible a cloranfenicol/ceftriaxona, por lo que se inicia antibioticoterapia con ceftriaxona-gentamicina, mostrando el paciente una notable mejoría clínica, disminuyendo su malestar general y normalizando la temperatura. Discusión: Debido a la difícil interpretación microbiológica de los cultivos, Aerococcus sp es un germen identificado tardíamente, lo cual puede ensombrecer el pronóstico. La antibioticoterapia precoz y la continua monitorización clínica y de laboratorio son las estrategias más útiles en su tratamiento.

Introduction: Aerococcus species is a Gram-positive bacteria regarded as a rare cause of urinary tract infections and infective endocarditis. Most cases have been described in elderly males with underlying genitourinary tract abnormalities. Case report: 55 years old male complains two-month period of malaise, continuous fever, diaphoresis, left-thoracic dull pain and weight loss of 8 kg in a month, presenting anorexia. With an unremarkable history except for a chronic urethral stricture with needed of periodic transurethral dilation, which where performed using a mercurial thermometer. Patient comes to the emergency room in regular conditions, querulous. Pulmonary examination with diminished left base vesicular breath sound plus bronchovesicular breath sound. Digital rectal examination painfull at palpation. Complementary laboratory test shows: 13.100/mm3 WBC, VHS of 63 mm/h, PCR on 21 mg/dL. In the context of fever of unknown origin it was performed a transthoracic echocardiography, which showed a 0.9 x 1 cm vegetation in left coronary valve. Blood cultures were positive for Aerococcus sp. sensitive to chloramphenicol /ceftriaxone, showing the patient a remarkable clinical improvement, diminishing his malaise and normalizing his temperature. Discussion: Owing to the frequent microbiologic misinterpretation of the cultures, the bacterial identification often is delayed, which could potentially lead to a fatal outcome. Aggressive-fast establishment of antiobiotic therapy and a continuous monitoring of the patient's clinical status and laboratory results are the most effective strategies in treatment.

Etiología de la neumonía en pacientes chilenos infectados por el virus de la inmunodeficiencia humana / Etiology of pneumonia in Chilean HIV-infected adult patients

Objectives: To establish the etiology of pneumonia and to compare the yield of diagnostic techniques for diagnosis of Pneumocystis jiroveci and Mycobacterium tuberculosis infections in HIV-1-infected patients. Patients and Methods: Subjects underwent sputum induction and bronchoalveolar lavage (BAL). Gram, Ziehl-Neelsen, silver stain (SS) and immunofluorescense staining (IF) for P. jiroveci, fluorescent stain for mycobacteria, PCR for P. jiroveci andM. tuberculosis, aerobic, fungal and mycobacterial cultures, respiratory viruses and CMV cultures were performed on the sputum and BAL. IgM for Mycoplasma pneumoniae and Chlamydophyla pneumoniae, and Legionella pneumophila urinary antigen were also obtained. Results: Sixty patients were included. An etiologic diagnosis was made in 97 percent. Pneumocystisjiroveci was the most frequent etiology (58 percent) followed by Streptococcus pneumoniae (12 percent), and Mycobacterium avium complex (12 percent). Mycobacterium tuberculosis was found in 5 percent. Conclusions: The comparison of diagnostic methods for P. jiroveci showed a higher sensitivity of IF and SS in BAL than in sputum, however PCR was equally sensitive in both samples. With this approach a precise etiologic diagnosis was reached in the great majority of patients. The most common etiology was P. jiroveci. IF in BAL remains the gold standard for diagnosis of P. jiroveci pneumonia.

Objetivos: Establecer la etiología de la neumonía y comparar el rendimiento de diferentes técnicas para el diagnóstico de las infecciones por Pneumocystis jiroveci y Mycobacterium tuberculosis en pacientes con infección por virus de inmunodeficiencia humana (VIH). Material y Métodos: De cada paciente se obtuvo esputo inducido y se efectuó LBA. A las muestras obtenidas se les realizó tinciones de Gram, Ziehl-Neelsen, plata e inmunofluores-cencia (IF) para P. jiroveci y M. tuberculosis; reacción de polimerasa en cadena (RPC) para ambos microorganismos; cultivos aeróbicos, fúngicos, para micobacterias, virus respiratorios y citomegalovirus. También se realizó determinación de IgM de Mycoplasma pneumoniae y Chlamydophyla pneumoniae y antígeno urinario de Legionella pneumophila. Resultados: Se incluyeron 60 pacientes, lográndose diagnóstico etiológico en 97 por ciento de los casos. Pneumocystis jiroveci fue la etiología más frecuente (58 por ciento), seguida por Streptococcus pneumoniae (12 por ciento) y Mycobacterium avium complex (MAC) (12 por ciento). Mycobacterium tuberculosis fue encontrado en 5 por ciento. Conclusiones: La comparación de los métodos diagnósticos para P. jiroveci mostró una mayor sensibilidad de la IF y tinción de plata en LBA que en esputo; sin embargo, la RPC fue igualmente sensible en ambos tipos de muestras. Con esta estrategia se logró establecer etiología en la gran mayoría de los pacientes. La etiología más común fue P. jiroveci. IF en LBA sigue siendo el estándar para el diagnóstico de la neumonía por P. jiroveci.

Candidiasis invasoras en el paciente crítico adulto / Invasive candidiasis in critically ill adult patient

Las infecciones invasoras por Candida spp, representan una patología relevante en los pacientes críticos. Para su oportuno diagnóstico es necesaria una elevada sospecha clinica, tomando en consideración el cuadro clinico y la presencia de factores de riesgo. Pese a la incorporación de nuevos fármacos al arsenal terapéutico durante la última década, mantiene una elevada mortalidad. Las claves para mejorar los desenlaces clínicos en estos pacientes son el empleo de una terapia precoz, eficaz y que permita la cobertura de distintas especies de Candida: C albicans y no albicans. Recientes guías internacionales sugieren la terapia empírica con equinocandinas ante la sospecha de candidiasis invasora en esta población de pacientes. Este grupo de fármacos ha documentado adecuada eficacia clínica y seguridad en estos pacientes. Se espera que la incorporación de nuevas equinocandinas al mercado aminore sus costos y mejore el acceso a este grupo de fármacos.

Invasive infections by Candida strains are a relevant pathology in critically ill patients. Candida should be considered where a high risk of infection is present for a critical early diagnosis. Despite the incorporation of new drugs in the therapeutic armamentarium over the last decade, mortality remains high. The key in improving clinical outcomes of these patients are the use of early effective therapies that offer coverage against different strains of Candida: C. albicans and non-albicans. Recent international guidelines suggest empiric therapy with echinocandins in suspected invasive candidiasis in this patient population. This group of drugs adequately documented clinical efficacy and safe use in these patients. The emergence of new echinocandins could improve access to these drugs by reducing their cost.

Neurosífilis en pacientes portadores y no portadores de VIH: descripción y comparación de dos cohortes históricas / Neurosyphilis in the patients with and without HIV infection: description and comparison of two historical cohorts

Neurosyphilis follows a more aggressive and different clinical course in HIV-infected patients compared to patients with normal immunity. Two historical series of patients with a diagnosis of neurosyphilis between 1995 and 2008 were compared: they included a group of 15 patients with y and 28 patients without HIV infection. Probability of neurosyphilis in patients with positive serum VDRL was increased in patients infected with HIV comparedto HIV negative patients (OR: 62.37 IC:95 percent (32.1-119.1) p value:< 0,001). Predominant clinical manifestations in neurosyphilis in the HIV negative group were ocular abnormality, vascular encephalic and spinal cord lesions. In the HIV positive group, they were fever, ocular abnormalities and headache. There were no differences in cerebrospinal fluid characteristics between both groups. Neurosyphilis was diagnosed even in patients with blood VDRL of < 1:32, that happened in 17.8 percent of the HIV positive patients with blood and in 60 percent of t he HIV negative patients. Penicillin sodium given at dose ¡Ý than 18.000.000 IU/day IV during 14 days was the most common treatment. In patients with clinical neurosyphilis, 93 percent of HIV negative group, and 54.2 percent of HIV positive group had persistent neurological after-effects. Three HIV positive patients died due to causes not related to neurosyphilis.

Reconocimiento de influenza-A como etiología de síndrome febril e insuficiencia respiratoria en adultos hospitalizados durante brote en la comunidad / Influenza-A as etiology of fever and respiratory insufficiency in adults hospitalized during an outbreak in Chile

Background : Influenza-A (IA) occurs every winter, is mostly observed among outpatients. Aim: To describe the clinical and epidemiological characteristics of cases that required hospital admission during an outbreak in Chile in 1999. Patients and methods: Adults subjects, with Influenza A confirmed by antigen detection test, hospitalized in the clinical hospital of the ½Hospital ClÝnico de la Universidad Católica de Chile¼ between May and June, with fever or respiratory symptoms were studied. A special record was designed to register clinical, microbiological and therapeutic data. Results: Fifty five cases, 26 males, aged 15 to 91 years, were studied. Eighty four percent had chronic concomitant diseases and 9.1 percent were immunosuppressed. Clinical findings were fever in 87.3 percent, asthenia in 83.6 percent, cough in 93.6 percent, abnormal pulmonary signs in 69 percent, an elevated C-reactive protein (mean value of 11.6 ± 7.1 mg/dL) and acute respiratory insufficiency in 54.5 percent. Cases were isolated in cohort or individual rooms and 38.2 percent were admitted to intensive or intermediate care units. Amantadine was prescribed to 52 patients and was well tolerated. Thirty three percent of cases developed pneumonia. These subjects were older, had more dyspnea and respiratory insufficiency than patients without pneumonia. Conclusions: IA should be borne in mind when dealing with hospitalized adults, during epidemic outbreaks in the community. The clinical picture can resemble a serious bacterial infection. An early diagnosis allows the use of specific treatments, to decrease the risk of nosocomial spread and to avoid unnecessary use of antibiotics (Rev MÚd Chile 2004; 132: 317-24).