Micobacterium avium complex en paciente inmunodeprimido: reporte de un caso / Mycobacterium avium complex in immunosuppressed patient: a case report

INTRODUCCIÓN: Dentro de las micobacterias atípicas destaca el Complejo Micobacterium Avium, cuyo nicho principal en humanos son los pacientes con inmunodeficencia. PRESENTACIÓN DEL CASO: Paciente masculino, 30 años, con antecedentes de infección por Virus de Inmonudeficiencia Humana en terapia antirretroviral y por virus Hepatitis B. Hospitalizado por cuadro de dolor abdominal asociado a síndrome consuntivo. Durante hospitalización se realizó Tomografía Computarizada que mostró múltiples adenopatías. Luego se realizó biopsia ganglionar que concluyó Tuberculosis ganglionar, comenzando con tratamiento antituberculoso. En el transcurso del tratamiento el paciente inició con sintomatología respiratoria y sus baciloscopías de esputo persistieron positivas, manteniéndose con dicho cuadro hasta confirmar la presencia de Micobacterium Avium en el cultivo, comenzando su tratamiento específico, con positivos resultados. DISCUSIÓN: El Complejo Micobacterium Avium corresponde a la causa más común de enfermedad por micobacteria no tuberculosa en inmunosuprimidos. Por lo tanto, es un patógeno que merece ser considerado al menos como diagnóstico diferencial en dicho tipo de pacientes. En el presente caso se evidencia tanto una sospecha como un diagnóstico tardío, lo que llevó a una demora en el inicio del tratamiento y a complicaciones sintomáticas del paciente. Es necesario para la pesquisa precoz, realizar cultivos tanto para M. tuberculosis como para micobacterias atípicas para mejorar pronóstico y a su vez disminuir el riesgo de complicaciones.

INTRODUCTION: Among the atypical mycobacteria, the Micobacterium Avium Complex stands out. Its main niche in humans is immunodeficient patients. CASE REPORT: 30 years old male patient, with a history of infection by Human Immunodeficiency Virus on antiretroviral therapy, and Hepatitis B virus. Hospitalized for abdominal pain associated with consumptive syndrome. During his hospitalization, a computerized tomography was performed, showing multiple adenopathies. Then, a lymph node biopsy was performed that concluded nodal tuberculosis, beginning with antituberculous treatment. During the course of this treatment, patient presented respiratory symptoms and sputum bacilloscopy persisted positive, maintaining this condition until the presence of Mycobacterium Avium was confirmed in the culture, beginning with specific treatment, with positive results. DISCUSSION: The Mycobacterium Avium Complex is the most common cause of nontuberculous mycobacterial disease in immunosuppressed patients. Therefore, its a pathogen that has to be considered at least as a differential diagnosis in such patients. In the present case, suspicion and a late diagnosis are evidenced, which lead to a delay in the initiation of treatment and complications for the patient. It is necessary for early screening, culture for both M. tuberculosis and atypical mycobacteria to improve prognosis and to reduce the risk of complications.

Evaluación del ambiente educacional pre-clínico en seis Escuelas de Medicina en Chile / Evaluation of the undergraduate educational environment in six medical schools in Chile

Background: The Dundee Ready Education Environment Measure (DREEM) is the most valid and reliable instrument to measure the educational environment (EE) in undergraduate medical education. Aim: To evaluate the EE perceived by undergraduate medical students in Chile, using a Spanish version of the DREEM questionnaire. Material and Methods: The DREEM was applied during 2008 in third, fourth and ffith undergraduate years of six medical schools. The individual results were calculated and means of both global and individual domain scores of the DREEM were compared, by year, gender and between different Schools. Results: One thousand ninety two students (77 percent of the total universe of students), answered the questionnaire. The mean score of the six Schools was 113.9. The domains of Perception of Learning and Social Self-Perception obtained the lower scores, with a global outcome indicating a more positive than negative EE. Two schools obtained mean scores of 128.32 and 126.87, that were significantly higher than the global scores obtained by other schools. No relevant differences by years or gender were observed. Conclusions: There is a signifiicant variability between the six schools evaluated and two of these obtained signifiicantly better scores than the rest. The identified positive and negative areas will orient the actions to improve the EE for undergraduate medical students.