Etiología viral de la hipoacusia sensorioneural súbita: ¿Mito o realidad? / Viral etiology of sensorineural sudden deafness: myth or reality?

Introducción: La hipoacusia sensorioneural súbita (HSNS), es una causa poco frecuente de hipoacusia. La mayoría son consideradas idiopáticas y sólo en el 10 por ciento-15 por ciento puede descubrirse un factor etiológico. Se han propuesto 4 teorías fisiopatológicas: viral, vascular, inmunológica y por ruptura de membranas. La etiología viral es controversial. Objetivo: Investigar la etiología viral como posible causa de HSNS y evaluar su presencia en relación con el pronóstico de recuperación auditiva. Material y método: Estudio descriptivo observacional de 24 meses, de pacientes con cuadro clínico de HSNS y exámenes compatibles. Previo al tratamiento se tomó hisopado y aspirado nasofaríngeo analizados mediante Microarray. Resultados: Se reclutaron 15 pacientes. En 9 se detectó virus respiratorio sincicial (VRS) y simultáneamente cuatro de ellos además otros virus (bocavirus, herpes VI y VII). No se detectaron casos de virus herpes I y II. No se han evidenciado diferencias en la evolución auditiva en el grupo con muestras positivas para virus. Conclusiones: La etiología viral de HSNS permanece en controversia. El 60 por ciento de los pacientes evaluados resultaron positivos, sin embargo, no hubo ningún virus herpes I ó II en las muestras. El VRS aparece como nuevo agente involucrado, aun cuando se encuentra fuera de temporada habitual.

Introduction: Sudden sensorineural hearing loss (SSHL) is a rare cause of hearing loss. Most are considered idiopathic and only 10-15 percent can discover an etiologic factor. Four pathophysiological theories have been proposed: viral, vascular, immunological and rupture of membranes. The viral etiology is controversial and there are reports with varying results. Aim: To investigate the viral etiology as a cause of HSNS and evaluate their presence in relation to the prognosis of hearing recovery. Material and method: descriptive, observational study of 24 months, patients with symptoms and exams compatible SSHL. Before treatment, nasopharyngeal aspirate was taken and then analyzed using Microarray. Results: Were enrolled 15 patients. In 9 was detected a respiratory syncytial virus (RSV) and four of them simultaneously also other viruses (Bocavirus, Herpes VI and VII). There were no cases of Herpes Virus I and II. There were no evidence differences in auditory development in the group with samples positive for virus. Conclusions: The viral etiology of SSHL remains controversial. 60 percent of patients tested were positive, however, there was no Herpes virus I or II in the samples. RSV appears as a new agent involved, even when was out of regular season.

Síndrome disentérico, insuficiencia renal aguda y shock séptico letal asociados a infección por salmonella enteritidis: descripción de 3 casos / Dysentery, acute renal failure and septic shock caused by salmonella enteritidis: report of 3 cases

Chile is being affected by an epidemic of S enteritidis infections since 1994, an increasingly important cause of morbidity wordwide. Although infections by this bacteria have been commonly associated ti diarrhea and patients are usually not affected by complications, three patients required admission by dysentery (not reported in most published series), acute renal failure (ARF) and septic shock (SS), respectively, at the end of the summer season. S enteritidis was isolated from stool cultures in all three cases. A female patient (24) with dysentery presented with fever and diarrhea associated with blood and mucus and localized abdominal pain in the lower right quadrant. Surgery was not required although laparotomy was considered in the first hours after admission. ARF was demonstrated in a male patient (50) by dehidration, increased creatinine plasma and BUN level (7,19 and 103 mg/dl, respectively), and increased urinary Na level and anion gap (35 mEq/l). Hemodialysis was not required. A third patient was admitted by SS (male, 57, alcoholic), as demonstrated by hypotension despite fluid reposition, altered mental status, and multiorgan compromise. Haemodynamic monitorization showed a high cardiac index and a low systemic vascular resistence. CPK serum determinations indicated rhabdomyolysis. Patients recovered satisfactorily, except SS patient, who died

Seroprevalencia de legionella pneumophila en Santiago: evidencias de exposición durante la infancia / Seroprevalence of legionella pneumophila in Santiago: evidence of exposure during chilhood

Se evaluó la exposición previa a legionella pneumophila de un grupo de 120 sujetos chilenos, sanos, menores de 20 años, estratificados según nivel socioeconómico. Las muestras de suero fueron analizadas, para la detección de anticuerpos de legionella pneumophila serogrupos 1 a 6, por técnica de inmunofluorescencia indirecta considerando positivos títulos iguales o mayores a 1:64. Doce de los 120 sujetos fueron positivos (10 por ciento); se observaron distintos grados de seroprevalencia según niveles socioeconómicos: 0/40 para el mas bajo; 2/40 (5 por ciento) en el nivel medio y 10/49 (25 por ciento) alto. El mayor título registrado fue 1:128. El nivel socioeconómico alto está asociado con la prevalencia mas alta de anticuerpos anti-legionella pneumophila en población chilena