Ventilator associated pneumonia: unravelling prevalence risk factor and antibiotic usage

Background: Hospital acquired infections, are a leading cause of mortality and morbidity. Ventilator associated pneumonia, one of the hospital acquired illnesses. The purpose of this study was to evaluate the prevalence, risk factors, causative organism, and antibiotic usage for the treatment of ventilator-associated pneumonia. Methods: Between May 2022 and October 2022, 50 patients participated in an ambispective and observational study conducted across several ICU departments at Adichunchanagiri Hospital, BG Nagara, Karnataka. Reviewing and evaluating daily patient case sheets, laboratory results, and treatment charts of participants who were hospital inpatients provided pertinent data needed for the study. Volunteers were enrolled after taking consent from each of them, a suitably designed data collection form was used to collect all the necessary information. Microsoft Excel was used to enter the data. Version 28 of SPSS was used to analyze the data. Statistical significance was determined by using a P-value of less than 0.05. Results: The study included 50 patients and discovered a 60% prevalence of ventilator-associated pneumonia in the general community. Staphylococcus aureus accounted for 26.7% of all gram-positive bacteria, whereas Enterobacter and Klebsiella species accounted for 16.7%. Metronidazole was given in 64% of instances, with accidents being the most frequent risk factor (40%). Conclusions: Within the specified population, the incidence of ventilator-associated pneumonia is 60%, with Staphylococcus aureus identified as the most predominant bacterial pathogen. Metronidazole is the most frequently prescribed antibiotic, and accidents are the key risk factors that cause ventilator-associated pneumonia.

Prevalence, risk factors, causative organism and antibiotic susceptibility of catheter associated urinary tract infections

Background: The most common nosocomial infection is catheter-associated urinary tract infection (CAUTI), with a 3-7% daily risk of developing CAUTI in acute care settings. This study's goal was to identify the prevalence, risk factors, causative organism of CAUTI and understanding the organism's current antimicrobial agent sensitivity profile. Methods: Total 120 patients participated in a prospective and observational study conducted at Adichunchanagiri Hospital, Karnataka. Reviewing and evaluating patient case sheets, laboratory results, and treatment charts of participants who were hospital inpatients provided data needed for the study. Microsoft Excel was used to enter the data and version 28 of SPSS to analyze the data. Statistical significance was determined by using a P-value of less than 0.05. Results: It was discovered that 12.5% of HAI cases were linked to catheter use. The most prevalent microbial agent in the current investigation was E. coli (41.7%). According to the current study, women are more likely than men to get UTIs. An underlying medical condition was found to have a strong correlation with UTIs in the current investigation. For CAUTI, drug resistance to cefotaxime and tigecycline was noted. Conclusions: The study suggested that gender, age extremes, use of antibiotics, length of stay in intensive care unit, diabetes mellitus, immunosuppressive medication, and indwelling urinary devices are the major risk factors for CAUTI. E. coli was the most common microbiological agent in the current study. Therefore, to assist doctors in the treatment and management of CAUTIs, ongoing surveillance of antimicrobial resistance patterns is required.

Aspirin and clopidogrel resistance in Filipino patients with recurrent noncardioembolic ischemic strokes in a tertiary hospital: A cross-sectional study

Background@#Antiplatelet resistance is one factor that contributes to stroke recurrence among patients with noncardioembolic ischemic strokes. @*Objectives@#This paper aims to describe the prevalence of aspirin and clopidogrel resistance, along with frequency of statin, NSAID and proton pump inhibitor use among our cohort of stroke patients. Method. This is a single-center cross-sectional review that included all adult patients with recurrent noncardioembolic ischemic stroke admitted in a tertiary hospital between January 2019 and June 2023. @*Results@#A total of 1,374 patients were admitted for ischemic stroke from January 2019 to June 2023. Among these, 155 (11.28%) were recurrent noncardioembolic ischemic strokes. Prevalence of aspirin and clopidogrel resistance were 25% and 32.7%, respectively. Clinical profiles of those in the resistant group were comparable with those in the nonresistant group. None of the patients taking aspirin had concomitant use of nonsteroidal antiinflammatory drugs. Only 2 of the patients who were resistant to clopidogrel were on proton pump inhibitors. More than half of the patients both in the resistant and the nonresistant groups were on statin. The study had a small sample size and hence it was not enough to establish causal relationship between factors and antiplatelet resistance. @*Conclusion@#More patients were resistant to clopidogrel than to aspirin. Further studies with a bigger sample size are recommended to explore factors that contribute to antiplatelet resistance in Filipino patients.

Glomerular parietal epithelial expression of CD44 in minimal change nephrotic syndrome and primary focal segmental glomerulosclerosis: A clinico-pathological study

Introduction: Minimal change nephrotic syndrome (MCNS) and focal segmental glomerulosclerosis (FSGS) are the two common causes of nephrotic syndrome (NS) in both children and adults with overlapping clinical features, but with distinct prognostic and therapeutic implications. The distinction between these relies entirely on histopathology, which can sometimes be difficult. CD44 is expressed by activated parietal epithelial cells, plays a role in matrix deposition and thus in the pathogenesis of FSGS. Aims: To assess the expression of CD44 in MCNS and FSGS and to evaluate its association with the known clinical and histopathological prognostic factors. Materials and Methods: Thirty cases each of MCNS and FSGS were studied. The clinical, laboratory, histopathological, and CD 44 immunohistochemical data were recorded. The findings were analyzed and correlated. A P value of < 0.05 was considered statistically significant. Results: Statistical association was noted between CD44 positivity and serum creatinine (p = 0.031), estimated glomerular filtration rate (p = 0.040), segmental sclerosis (p < 0.001), tubular atrophy (p = 0.027), interstitial fibrosis (p = 0.027), and histological diagnosis (p < 0.001). The sensitivity, specificity, positive predictive, and negative predictive values were 90%, 76.67%, 79.41% and 88.46%, respectively. Conclusions: CD44 immunostain can effectively distinguish MCNS from FSGS. The congruent results of CD44 positivity with known prognostic factors support the possibility of using the CD44 marker as a predictive tool in selecting high-risk patients and offering appropriate therapeutic measures.

Plant galls recorded from Guanacaste Conservation Area-Costa Rica as an integrated concept of a biological database / Registro de galhas em plantas da Área de Conservação Guanacaste, Costa Rica, como conceito integrado de um banco de dados biológico

Abstract: Galling insects are specialist herbivorous that have the ability of manipulating plant tissue to form complex biological structures called galls. Even though different organisms have the ability to induce galls in plants, insect galls have the highest degree of structural complexity. The main goal of this study was to obtain a preliminary systematic record of plant gall morphotypes from the Guanacaste Conservation Area in Costa Rica and integrate the information into a biological database. Plant gall morphotypes were recorded, characterized and deposited into a specialized herbarium established as a reference for the inventory. Moreover, organisms associated with gall morphotypes were included in the inventory when it was possible to obtain and identify them. Galls were collected in the rainy season over a period of three years. In total, we recorded forty-four families, seventy genera, and eighty-seven host plant species. One hundred thirty-one morphotypes of plant galls were identified in the Guanacaste Conservation Area. The family with the highest number of gall morphotypes was Fabaceae (8.4%). Leaves were the organ with the largest number of galls (71%), followed by stems (17.6%), and apical buds (6.9%). The predominant gall shape was globular (25.2%), followed by discoid (18.3%). Fifty-nine percent of the galls had a glabrous texture, which was most common on leaves, with 77%. One hundred twenty of our field records (91.6%) of plant galls were new morphotypes not only for Costa Rica but also the world. As a consequence of this research and considering the prospect of future increases in new gall records (and associated organisms), we proposed having the biological entities resulting from the inventory placed in a cecidiarium. This repository represents a standardized and comprehensive way to manage the data and biological materials associated with the plant galls. We also suggest a nomenclature for standardizing gall morphotype registries and identifications. This work is the first and most detailed inventory of plant galls carried out thus far in the Guanacaste Conservation Area.

Resumo: Os insetos galhadores são herbívoros especializados, que têm a habilidade de manipular os tecidos vegetais, formando uma complexa estrutura biológica. Diferentes organismos têm a capacidade de induzir galhas, porém as de insetos têm maior grau de complexidade estrutural. O principal objetivo desse estudo foi realizar um levantamento sistemático preliminar das galhas de insetos na Área de Conservação Guanacaste, na Costa Rica, e inserir as informações em uma base de dados biológicos. Os morfotipos de galhas foram registrados, caraterizados e depositados em um herbário estabelecido como base de referência deste inventário. Além disso, quando foi possível obter e identificar os organismos associados a cada morfotipo de galha, eles foram incluídos no inventário. As amostras de galhas foram coletadas na estação chuvosa, durante três anos. No total, foram registradas 44 famílias, 70 gêneros e 87 espécies de plantas hospedeiras. Cento e trinta e um morfotipos de galhas foram identificados na Área de Conservação de Guanacaste. A família com o maior número de morfotipos de galhas foi Fabaceae (8.4%). Os órgãos vegetais com o maior número de galhas foram as folhas (71,0%), seguidas dos caules (17,6%), e das gemas apicais com 6,9%. A forma predominante das galhas foi globoide (25,2%), seguida da lenticular (18,3%) e 59% das galhas apresentaram textura glabra, observada mais frequentemente folhas (77%). Cento e vinte morfotipos de galhas (91.6%) representaram novos registros não só na Costa Rica como também no mundo. Como consequência desta pesquisa e considerando as perspectivas de aumentos futuros de novos registros de galhas (e organismos associados), nós propomos que as entidades biológicas resultantes deste inventário sejam depositadas em um cecidiário. Este repositório representa uma maneira padronizada e abrangente de gerenciar e integrar os dados e os materiais biológicos associados às galhas das plantas. Também sugerimos uma terminologia para padronizar os registros e identificações dos morfotipos de galhas. Este inventário de galhas em plantas é o primeiro e o mais detalhado já realizado na Área de Conservação Guanacaste.

Obstrucción mecánica secundaria a íleo biliar / MECHANICAL OBSTRUCTION SECONDARY TO GALLSTONE ILEUS

Gallstone ileus is defined as a mechanical intestinal obstruction secondary to the presence of a gallstone. Less than 1% of cases of intestinal obstruction are derived from this etiology. The most frequent cause is the impaction of the stone in the ileum, after passing through a bilioenteric fistula. It is a rare and potentially serious complication of cholelithiasis. This pathology occurs more in the elderly, the average age at which it occurs is between 60 and 84 years, mainly affecting the female sex, attributed to the higher frequency of biliary pathology in said sex. It presents a high morbidity and mortality, mainly due to the difficulty and the diagnostic delay.

Plants and gall hosts of the Tirimbina Biological Reserve, Sarapiqui, Costa Rica: Combining field sampling with herbarium records

There has been an increasing number of inventories of gall-inducing arthropods in the Neotropics. Nonetheless, very few inventories have been carried out in areas where the flora is well documented, and records of galls from herbaria and sites outside the study area have seldom been utilized. In this study we provide a checklist of the native vascular plants of a 345 ha forest reserve in the Caribbean lowlands of Costa Rica and document which of these plants were found to harbor galls. The gall surveys were carried out between November 2013 and December 2016. We also cross-checked our plant list with the previous gall records from elsewhere in the country and searched for galls on herbarium specimens of dicots reported from the reserve. In total, we recorded 143 families and 1174 plant species, of which 401 were hosts of galls. Plant hosts of galls were found in the following non-mutually exclusive categories: 209 in our field sampling, 257 from previous records, and 158 in herbarium specimens. Of our field records of galls, 77 were new for the country, 77 were also found in the herbarium and 110 had been previously recorded in the country. Herbarium specimens and previous records are good indicators of potential gall hosts but around one quarter (40/158) of the gall records in the herbarium were ambiguous as to whether the tissue alteration was a gall or not. Plant family size was related to number of gall hosts, but most dicot families have similar proportions of gall host species. We concluded that more than a third of the native plants in the reserve are gall hosts, but this number increased to 44.93 % when only dicots were considered. Our results demonstrate the utility of providing complete plant inventories when conducting gall inventories, and of using herbarium specimens and previous galls studies to infer gall diversity in a specific area.

Los estudios relacionados con la diversidad de insectos inductores de agallas han venido aumentando en el Neotrópico. Sin embargo, pocos inventarios se han realizado en sitios donde la flora está bien documentada y los registros previos de agallas, así como información disponible de herbario, han sido subutilizados. En este estudio brindamos un inventario de las plantas nativas en una reserva de 345 ha ubicada en las tierras bajas del Caribe costarricense y documentamos cuales de estas son hospederas de agallas. El muestreo de agallas se llevó a cabo entre noviembre del 2013 y diciembre del 2016. Así mismo, comparamos nuestra lista de plantas con los registros previos de agallas encontradas en el resto del país y examinamos en herbario todas las dicotiledóneas registradas en la reserva en busca de agallas. En total, encontramos 143 familias y 1 174 especies de plantas de las cuales 401 especies fueron hospederas de agallas. Estas fueron encontradas de las siguientes categorías no mutuamente exclusivas: 209 mediante colectas de campo, 257 a partir de registros previos y 158 en material de herbario. De las plantas con agallas encontradas en el campo 77 corresponden a registros nuevos para el país, 77 fueron halladas también en herbario y 110 habían sido reportadas anteriormente en el país. El material de herbario y los registros previos demostraron ser buenos indicadores de las potenciales especies de plantas hospederas de agallas, sin embargo, alrededor de una cuarta parte (40/158) de los registros de agallas en herbario son ambiguos (difíciles de determinar si son agallas o no). El tamaño de la familia de las plantas está relacionado con la diversidad de especies de plantas hospederas de agallas, no obstante, la mayoría de las familias de dicotiledóneas tiene una proporción similar de especies hospederas de agallas. Concluimos que al menos un tercio de las especies de plantas nativas de la reserva son hospederas de agallas, pero este número incrementa a 44.93 % cuando solo se consideran las dicotiledóneas. Nuestros resultados demuestran la importancia de proveer inventarios completos de plantas cuando se realizan inventarios de agallas, así como la utilidad de examinar material de herbario y contrastar registros previos para inferir la diversidad de agallas en un sitio.

Intermittent theta-burst transcranial magnetic stimulation for autism spectrum disorder: an open-label pilot study

Objective: Theta-burst stimulation (TBS) modulates synaptic plasticity more efficiently than standard repetitive transcranial magnetic stimulation delivery and may be a promising modality for neuropsychiatric disorders such as autism spectrum disorder (ASD). At present there are few effective interventions for prefrontal cortex dysfunction in ASD. We report on an open-label, pilot study of intermittent TBS (iTBS) to target executive function deficits and restricted, repetitive behaviors in male children and adolescents with ASD. Methods: Ten right-handed, male participants, aged 9-17 years with ASD were enrolled in an open-label trial of iTBS treatment. Fifteen sessions of neuronavigated iTBS at 100% motor threshold targeting the right dorsolateral prefrontal cortex were delivered over 3 weeks. Results: Parent report scores on the Repetitive Behavior Scale Revised and the Yale-Brown Obsessive Compulsive Scale demonstrated improvements with iTBS treatment. Participants demonstrated improvements in perseverative errors on the Wisconsin Card Sorting Test and total time for the Stroop test. The iTBS treatments were well tolerated with no serious adverse effects. Conclusion: These preliminary results suggest that further controlled interventional studies of iTBS for ASD are warranted.

Estimation of Aedes aegypti (Diptera: Culicidae) population size and adult male survival in an urban area in Panama

Traditional mosquito control strategies rely heavily on the use of chemical insecticides. However, concerns about the efficiency of traditional control methods, environmental impact and emerging pesticide resistance have highlighted the necessity for developing innovative tools for mosquito control. Some novel strategies, including release of insects carrying a dominant lethal gene (RIDL®), rely on the sustained release of modified male mosquitoes and therefore benefit from a thorough understanding of the biology of the male of the species. In this report we present the results of a mark-release-recapture study aimed at: (i) establishing the survival in the field of laboratory-reared, wild-type male Aedes aegypti and (b) estimating the size of the local adult Ae. aegypti population. The study took place in Panama, a country where recent increases in the incidence and severity of dengue cases have prompted health authorities to evaluate alternative strategies for vector control. Results suggest a life expectancy of 2.3 days for released male mosquitoes (confidence interval: 1.78-2.86). Overall, the male mosquito population was estimated at 58 males/ha (range 12-81 males/ha), which can be extrapolated to an average of 0.64 pupae/person for the study area. The practical implications of these results are discussed.

The Association between Influenza Treatment and Hospitalization-Associated Outcomes among Korean Children with Laboratory-Confirmed Influenza

There are limited data evaluating the relationship between influenza treatment and hospitalization duration. Our purpose assessed the association between different treatments and hospital stay among Korean pediatric influenza patients. Total 770 children < or = 15 yr-of-age hospitalized with community-acquired laboratory-confirmed influenza at three large urban tertiary care hospitals were identified through a retrospective medical chart review. Demographic, clinical, and cost data were extracted and a multivariable linear regression model was used to assess the associations between influenza treatment types and hospital stay. Overall, there were 81% of the patients hospitalized with laboratory-confirmed influenza who received antibiotic monotherapy whereas only 4% of the patients received oseltamivir monotherapy. The mean treatment-related charges for hospitalizations treated with antibiotics, alone or with oseltamivir, were significantly higher than those treated with oseltamivir-only (P < 0.001). Influenza patients treated with antibiotics-only and antibiotics/oseltamivir combination therapy showed 44.9% and 28.2%, respectively, longer duration of hospitalization compared to those treated with oseltamivir-only. Patients treated with antibiotics, alone or combined with oseltamivir, were associated with longer hospitalization and significantly higher medical charges, compared to patients treated with oseltamivir alone. In Korea, there is a need for more judicious use of antibiotics, appropriate use of influenza rapid testing.

A Checklist of the Basidiomycetous Macrofungi and a Record of Five New Species from Mt. Oseo in Korea

Basidiomycetous macrofungi play important roles in maintaining forest ecosystems via carbon cycling and the mobilization of nitrogen and phosphorus. To understand the impact of human activity on macrofungi, an ongoing project at the Korea National Arboretum is focused on surveying the macrofungi in unexploited areas. Mt. Oseo was targeted in this survey because the number of visitors to this destination has been steadily increasing, and management and conservation plans for this destination are urgently required. Through 5 field surveys of Mt. Oseo from April to October 2012, 116 specimens of basidiomycetous macrofungi were collected and classified. The specimens were identified to the species level by analyzing their morphological characteristics and their DNA sequence data. A total of 80 species belonging to 57 genera and 25 families were identified. To the best of our knowledge, this is the first study to identify five of these species-Artomyces microsporus, Hymenopellis raphanipes, Pholiota abietis, Phylloporus brunneiceps, and Sirobasidium magnum-in Korea.

Current recommendations for cervical cancer screening: do they render the annual pelvic examination obsolete?

The development of a screening test for cervical dysplasia has been a major force in diminishing the worldwide incidence of invasive cervical cancer. Screening intervals recommended by professional organizations have changed over the past half century. Recognition of the human papillomavirus [HPV] as the causative agent and enhanced understanding of the natural history of HPV and cervical dysplasia in different age groups have prompted the American College of Obstetricians and Gynecologists and other professional societies to defer Pap smear screening to intervals no less than 2 years apart in women 21-29, and every 3 years in women 30 and over assuming no prior history of cervical dysplasia. Screening should start no sooner than age 21. These recommendations more closely resemble those currently practiced in Europe and other parts of the developed world. Those who have undergone hysterectomy no longer need screening unless high-grade dysplasia was present. Although the value of pelvic examination is not debated in women with symptoms referable to the female genital tract, the endorsement by several professional societies of less than annual cervical cancer screening in healthy women also begs the question of whether annual pelvic examination [speculum and/or bimanual examination] benefits asymptomatic women. Some sexually transmitted infections are amenable to self-insertion of a vaginal probe or detectable by voided urine specimen. Bimanual examination is insensitive in detecting early ovarian cancer with a high false-positive rate leading to patient anxiety, excessive diagnostic testing, and unnecessary surgical procedures. Future study should focus on the frequency in which healthy asymptomatic women should undergo pelvic examination

Trends in Pneumonia and Influenza-associated Hospitalizations in South Korea, 2002-2005.

Pneumonia and influenza are leading causes of morbidity and mortality across the globe. Korea has established the national health-insurance system to cover the entire Korean population since 1989. The aim of this study was to describe the epidemiologic trends in pneumonia and influenza-associated hospitalizations and deaths using the Korean National Health Insurance databases and national vital statistics. During 2002-2005, 989,472 hospitalizations and 10,543 deaths due to pneumonia and influenza were recorded. Eighty-one percent of the hospitalizations were related to diagnoses with unspecified aetiology. The average annual rate of hospitalizations due to pneumonia and influenza was 5.2 per 1,000 people [95% confidence interval (CI) 5.2-5.3], and the hospitalization rate increased by 28% (from 4.5 to 5.8 per 1,000 people) during the four-year study period. In addition, deaths due to pneumonia and influenza increased by 48% (2,829 during 2003, 3,522 during 2004, and 4,192 during 2005). Overall, the national burden of hospitalizations and deaths due to pneumonia and influenza in Korea was high, and it increased for all age-groups during the study period. A comprehensive review of potential interventions by the government authorities should aim to reduce the burden of pneumonia and influenza.

Serum and salivary cortisol in the diagnosis of adrenal insufficiency and as a predictor of the outcome in patients with severe sepsis / Avaliação do cortisol sérico e salivar no diagnóstico da insuficiência adrenal e como parâmetro preditor da evolução de pacientes com sepse grave

OBJECTIVES: To compare salivary with serum total cortisol in patients with severe sepsis, postoperative patients and healthy controls. MATERIALS AND METHODS: Serum total cortisol was determined by chemiluminescence immunoassay; salivary cortisol was determined by enzyme immunoassay. RESULTS: In patients with severe sepsis, median concentration of salivary cortisol was 14.0 and 2.6 higher than that of postoperative patients and healthy subjects. In postoperative patients, salivary cortisol was 5.4 times higher than in control patients. Serum total cortisol was also higher in patients with severe sepsis than in controls and postoperative patients. This increment, however, was much lower (2.33 and 1.64, respectively). Patients with a salivary cortisol greater than 7.2 µg/dL had a mortality rate of 80 percent, a statistically significant result when compared with the group with lower cortisol levels (Z = 2.38 and p < 0.05). CONCLUSIONS: Salivary cortisol in critically ill patients may be a better laboratory indicator of cortisol levels than serum total cortisol.

OBJETIVOS: Comparar cortisol salivar com sérico total em pacientes com sepse grave, em pós-operatório e controles normais. MATERIAIS E MÉTODOS: Cortisol sérico total foi determinado por imunoensaio quimioluminescente e cortisol salivar por imunoensaio enzimático. RESULTADOS: Em pacientes com sepse grave, a mediana do cortisol salivar foi 14,0 e 2,6 vezes maior que dos pacientes em pós-operatório e saudáveis. Nos pacientes em pós-operatório, cortisol salivar foi 5,4 vezes maior que o controle. Cortisol sérico total também foi maior em pacientes com sepse grave que nos saudáveis e pós-operatórios, porém, esse incremento foi bem menor (2,33 e 1,64, respectivamente). Pacientes com cortisol salivar superior a 7,2 µg/dL tiveram mortalidade de 80 por cento, com significância estatística, quando comparado com os pacientes com níveis mais baixos (Z = 2,38 e p < 0,05). CONCLUSÕES: Cortisol salivar em pacientes críticos parece ser um melhor marcador da atividade glicocorticoide que o cortisol sérico total.

Multispecies communities: interspecies interactions influence growth on saliva as sole nutritional source / 国际口腔科学杂志·英文版

Human oral bacteria live in multispecies communities in the biofilm called dental plaque. This review focuses on the interactions of seven species and the ability of each species individually and together with other species to grow on saliva as the sole source of nutrient. Community formation in biofilms in flow cells is monitored using species-specific fluorophore-conjugated immunoglobulin G, and images are captured by confocal microscopy. Early colonizing veillonellae emerge from this review of interspecies interactions in saliva as a critical genus that guides the development of multispecies communities. Highly selective interspecies recognition is evident as initial colonizers pair with early and middle colonizers to form multispecies communities that grow on saliva.

Peste neumónica primaria con transmisión intrahospitalaria en La Libertad, Perú 2010 / Primary pneumonic plague with nosocomial transmission in La libertad, Peru 2010

La peste neumónica es una forma clínica de peste, de baja frecuencia y alta letalidad, transmitida por la inhalación directa de Yersinia pestis proveniente de un animal o de persona a persona. Objetivo: Describir las características clínicas y epidemiológicas de los casos de un brote de peste neumónica primaria humana en el norte de Perú. Materiales y Métodos. Se revisaron las historias clínicas de los casos confirmados de peste neumónica primaria presentados en un brote ocurrido en la región de La Libertad, en el mes de julio de 2010, asimismo, se efectuó la búsqueda e investigación de contactos. Resultados: Se identificó el caso Índice y tres casos adicionales, de estos últimos, dos fueron infecciones intrahospitalarias relacionadas con el caso índice. La presentación clínica inicial se caracterizó por fiebre de inicio súbito, escalofríos, mialgias y dolor torácico y evolución en menos de 24 horas a hipotensión arterial y cianosis. El inicio del tratamiento específico varió de 2 a 12 días, observándose que los casos con inicio precoz de tratamiento tuvieron un mejor resultado clínico. La lealtad fue de 50 por ciento (2/4). Conclusión: Se evidenció la transmisión intrahospitalaria de peste neumónica en el Perú con manifestaciones graves y alta letalidad.

Pneumonic plague is one of the clinical forms of plague, of low frequency and high mortality, transmitted by direct inhalation of Yersinia pestis coming from an animal or from person to person. Objective. To describe the clinical and epidemiological characteristics of the cases of primary pneumonic plague in an outbreak in the north of Peru. Materials and methods. The clinical records of the confirmed cases of primary pneumonic plague presenting in an outbreak occurring in La Libertad, in July 2010, were reviewed, also the search and contact investigation was performed. Results. The index case was identified, as well as three additional cases, out of these, two were nosocomial infections related to the index case. The initial clinical presentation was characterized by sudden onset of fever, chills, myalgia and chest pain, which in less than 24 hours evolved to hypotension and cyanosis. The initiation of specific treatment varied from 2 to 12 days, and cases with prompt initiation of treatment had a better clinical outcome. The lethality was 50 percent (2/4). Conclusion. Nosocomial transmission of pneumonic plague in Peru is evidenced, with severe clinical manifestations and high lethality.