Infecciones articulares / Joint infections

La infección articular sigue siendo un motivo relativamente frecuente de consulta, tanto en los Servicios de Urgencia como en las consultas del médico general. De ahí que el diagnóstico precoz y la derivación oportuna para el inicio de un tratamiento mixto que considera el uso adecuado de esquemas antibióticos asociado a aseo quirúrgico, son cruciales en su manejo y pronóstico -que aun no se encuentra exento de complicaciones incluso de mortalidad en algunos pacientes con enfermedades predisponentes-. En esta revisión se realiza un análisis referente al diagnóstico y tratamiento oportuno que a menudo requiere de la participación de distintos especialistas para un mejor resultado en beneficio de la funcionalidad articular y/o de una complicación de mayor riesgo para el paciente.

Características clínicas e historia natural de la infección por virus de inmunodeficiencia humana: estudio de una población chilena atendida en un centro piloto multiprofesional / Clinical characteristics and natural history of human immunodeficiency virus infection: study of a chilean population from a pilot multi-professional center

Four hundred and eighty six infected adults (90,7 percent men) were prospectively followed from 1988 to 1993 at a multi-professional center in Santiago, Chile. 87,8 percent of male patients (pts), 84 percent of them homo/bisexual, and 64,4 percent of women acquired the infection sexually. At the beginning of the follow up (F/U) 51 percent of men and 71 percent of women were asymptomatic and 30 percent of the total group had AIDS. (AIDS definition: CDC 1993, excluded CD4 lymphocyte count <200 x mm3). 240/486 (49,4 percent) had developed AIDS at the end of the study (12/31/93). AIDS defining events (ADE) were: interstitial pneumonia (confirmed or suggestive as caused by P. carinii [PCP]), 25 percent; tuberculosis (all forms), 22.1 percent; wasting, 13.8 percent; Kaposi Sarcoma, 9.2 percent; esophageal candidiasis, 6.7 percent; isosporiasis, 5,4 percent. Of all PCP cases, 72 percent were ADE, the rest, post AIDS'. As expected, AIDS pts continued having major complications (mainly bacterial pneumonias, PCPs, esophagitis, tuberculosis and diarrhea due to I. belli and Cryptosporidium. Less frequently, but also observed, were toxoplasmic encephalitis and cryptococcal meningitis). Known mortality (excluded abandonment of F/U) was 27 percent for the whole group and varied from 5.8 percent, 51,6 percent to 69.2 percent for the first, 4th and 6th yaer of F/U respectively. For II-III CDC pts the mortality was 5 percent and 57 percent and for IV CDC pts it was 38 percent and 100 percent during the first and 6th year of F/U respectively. 36 percent, 53 percent, 74 percent and 85 percent of the pts followed for 1, 3, 5 and 6 years respectively had developed AIDS by the end of 1993. Multifactorial causes with either diarrhea, wasting or both were responsible for the death in half the pts in whom this was known, 15 percent died of respiratory complications and 5,7 percent of cryptococcal meningitis. 80 percent of AIDS pts survived their ADE. This study has provided information about the clinical profile of the HIV infection and natural history of the disease in Chile