Diferencias y similitudes clínicas y epidemiológicas de la neumonía viral en dos pandemias

Background: In a decade, we faced two pandemic viruses, influenza A H1N1pdm09 and SARS CoV-2, whose most serious manifestation is pneumonia. Aim: To compare the clinical, epidemiological and management aspects of pneumonias caused by each pandemic virus in adults requiring hospitalization. Material and Methods: Comparative, observational study carried out at a regional Chilean hospital, including 75 patients with influenza A H1N1pdm09 prospectively studied in 2009 and 142 patients with SARS-CoV-2 studied in 2020. Results: Patients with SARS-CoV-2 pneumonia were older (56 and 39.7 years respectively, p < 0.01) and had significantly more comorbidities. Cough, fever and myalgias were more frequent in influenza. Dyspnea was more frequent in COVID-19. Patients with COVID-19 had more extensive lung involvement and a longer hospitalization (13.6 and 8.6 days respectively, p = 0.01). There was no difference on ICU admission requirements and mortality attributable to pneumonia. Patients with influenza had greater APACHE scores and a higher frequency of a PaO2/FiO2 ratio ≤ 200. During COVID-19pandemic chest sean replaced x-ray examination. Also high-flow nasal cannulas and awake prone position ventilation were added as treatments. Conclusions: COVID-19 patients were older, had fewer classic flu symptoms but more dyspnea and longer hospitalization periods than patients with influenza.

Neumonía neumocócica bacteriémica en adultos en hospital regional de Chile / Bacteremic pneumococcal pneumonia in adults admitted to a general hospital: experience in 60 cases

Background: Bacteremic pneumococcal pneumonia (BPP) is a preventable disease with high morbimortality. Aim: To evaluate clinical aspects and mortality on BPP patients admitted to a Chilean regional hospital. Patients and Methods: We looked for adult patients with Streptococcus pneumoniae isolated from blood cultures between 2010 and 2014 years and reviewed clinical records of those who were admitted with pneumonia. Results: We identified 70 BPP patients: 58% were men, mean age was 56 years, 30% were > 65 years, 70% with basic public health insurance, 26% were alcoholics, 86% had comorbidities. Only two patients were vaccinated against S. pneumoniae. CURB-65 severity index for community acquired pneumonia was > 3 in 37% of patients. Twenty-four patients were admitted to ICU, twenty required mechanical ventilation and twenty-four died (34%). Mortality was associated with an age over 65 years, presence of comorbidities and complications of pneumonia. A total of 22 serotypes of S. pneumoniae were identified, five of them (1,3,7F,14 y 9V) were present in 57% of cases. Conclusions: Elevated mortality of our BNN patients was associated with comorbidities and possibly with socio economic factors, which conditioned a late access to medical care.

Impacto clínico de la influenza A H1N1 pandémica en el hospital de Puerto Montt, Chile / Clinical impact of pandemic influenza A H1N1 in a Chilean regional hospital

Background: Pandemic flu (H1N1 ) strongly affected southern Chile during2009. Aim: To report the logistic and organizational changes implemented at a regional hospital to face the pandemic. Material and Methods: All patients with flu like disease that were hospitalized, were prospectively enrolled at the Puerto Montt hospital. A nasopharyngeal aspirate was obtained in all for influenza virus A and B direct immunofluorescence and polymerase chain reaction (PCR). All epidemiological and clinical data of patients were recorded. Results: Between May 29 and July 7, 2009, 184 adults were admitted to the hospital and in 117patients aged 41 ± 18 years (56 percent females ), direct immunofluorescence was positive for influenza. In 67 of these patients PCR did not confirm the disease. These unconfirmed patients had a mean age of 49 ± 19 years (p < 0.01, compared with confirmed cases) and had a lower frequency of fever, rhinorrhea and chills. No significant differences in the incidence of community acquired pneumonia or chest X ray findings were observed between confirmed and unconfirmed cases. Hospital stay was over 15 days in 14 percent of confirmed cases and 5 percent of unconfirmed cases (p = 0.03). Fifteen patients, aged 53 ± 18 years, died. Conclusions: Low sensibility of direct immunofluorescence and delay in obtaining PCR confirmation of influenza posed a problem for the management of these patients.

Hantavirus asociado a sepsis estafilocócica: caso clínico / Hantavirus infection associated to a staphylococcal sepsis: report of one case

We report a previously healthy 36-year-old mole who developed a pulmonary syndrome caused by Hantavirus infection. He was admitted to an intensive care unit in shock and respiratory failure and died four hours after admission. Blood cultures were positive for Staphylococcus aureus. This patient could be an index case that shows, for the first time, an association of Hantavirus Pulmonary Syndrome with Staphylococcus aureus infection similar to what happens with other viruses.

Neumonía adquirida en la comunidad en el anciano hospitalizado: aspectos clínicos y nutricionales / Community-acquired pneumonia in the elderly: clinical and nutritional aspects

Community acquired pneumonia (CAP) in the elderly has unique features and there is little information about the effects of nutrition status on its outcome. Aim: To assess the clinical manifestations and prognostic factors of CAP in immunocompetent elderly patients requiring hospitalization. Patients and methods: Prospective study of all patients with CAP, admitted to Puerto Montt Hospital, Chile over one year. Epidemiológica! and clinical information and laboratory results were recorded. A nutritional assessment was also performed. Outcomes of elderly (>65 years) and young patients were compared. Results: Two hundred patients aged 63± 19 years were studied. Of these, 109 were older than 65 years (78.4±8 years) and 91 were younger than 65years (45.5±11 years). Multiple associated diseases, altered mental status, absence of fever, malnutrition and mortality were more common in the older group. Suspected aspiration pneumonia was more common in younger patients, probably related to alcoholism. Malnutrition was associated with longer hospital stay and mortality at any age. An univariate analysis showed that a low serum albumin (<3.4 g/dl) and a mid arm muscle circumference below the 25th percentile were associated with higher mortality. Conclusions: CAP in the elderly has specific features and malnutrition is associated with a worse prognosis in young and elderly patients.

Etiologíay factores pronósticos de la neumonía adquirida en la comunidad en el adulto hospitalizado, Puerto Montt, Chile / Etiology and prognostics factors of community-acquired pneumonia among adults patients admitted to a regional hospital in Chile

Background: Community-acquired pneumonia (CAP) is a common and serious illness in Chile. Aim: To evaluate the etiology, severity, prognostic factors and blood culture yield of CAP requiring hospitalization in Puerto Montt in Southern, Chile. Patients and methods: All non immunocompromised adults with CAP admitted at Puerto Montt Hospital during one year, were prospectively studied. Clinical and radiological assessment was done in all patients. Blood and sputum cultures were obtained and serology for atypical agents was determined. Results: We studied 200 patients, aged 63±19 years (109 males). The prognostic factors associated with mortality were an age over 65 years, an altered mental status, shock and acute renal failure. Etiology was demonstrated in 29% of patients. The most frequent pathogens were Streptococcus pneumoniae (40.7%), Haemophilus influenzae (23.7%) and Chlamydia pneumoniae (16.9%). Mixed infections were found in 17%. Fifteen atypical pathogens were identified in 12 patients. Of these only two received a specific treatment but no one died and their length hospital stay was similar than in the rest of the patients. Overall, blood cultures were positive in 12.5% of patients, but among alcoholics, 58% were positive. In only one percent of cases, positive cultures motivated therapeutic changes among clinicians. Eight percent of S pneumoniae strains were penicillin resistant. Conclusions: Atypical agents were a common cause of CAP in this group of patients, but their pathogenic role and treatment requirements are debatable. Focusing blood cultures on specific groups could improve their yield. The rate of Penicillin resistance for S pneumoniae was low.

Susceptibilidad a penicilina en cepas de Streptococcus pneumoniae aisladas en el Hospital de Puerto Montt, 1995-2003 / Penicillin susceptibility in Streptococcus pneumoniae strains isolated at Puerto Montt Hospital between 1995 and 2003

Background: The emergence and dissemination of resistance to penicillin among Streptococcus pneumoniae changed the approach to empiric antimicrobial therapy. Aim: To evaluate the in vitro susceptibility to penicillin in all S. pneumoniae strains isolated in Puerto Montt Hospital between 1995 and 2003. Material and methods: We revised all Microbiology Laboratory files of this period. Identification and antimicrobial susceptibility study methods for S pneumoniae did not change during the study period. Results: Six hundred eighteen S pneumoniae strains were identified. Of these, 66% came from adults and 48% from invasive diseases. Only 1.9% of strains were penicillin resistant and 7.6% had intermediate sensibility. Strains isolated from children and those isolated from non sterile sources had non significantly higher resistance levels. The susceptibility did not change along the years of the study. Conclusions: Among S pneumoniae strains isolated at Puerto Montt Hospital, the prevalence of penicillin resistance is low.

Neumonía neumocócica bacterémica en 45 adultos inmunocompetentes hospitalizados: cuadro clínico y factores pronósticos / Bacteremic pneumococcal pneumonia in 45 hospitalized adults

Background: The presence of bacteremia during a pneumococcal pneumonia is a sign of bad prognosis. Aim: To report a clinical experience with bacteremic pneumococcal pneumonia. Patients and methods: We reviewed the clinical and laboratory data from 45 adults (36 male, aged 17 to 97 years) with community acquired pneumonia (CAP) and Streptococcus pneumoniae bacteremia, hospitalized between January 1997 and August 2002 at the Puerto Montt Hospital (Southern Chile). Results: Eighty four percent of patients had underlying aggravating conditions, mainly alcoholism (40 percent), chronic obstructive lung disease (17.8 percent) and renal failure (17.8 percent). Seven percent were homeless. Fever, cough, dyspnea and sputum were the most common presenting symptoms. Five patients had pleural involvement. Four strains (8.9 percent) of S. pneumoniae had diminished susceptibility to penicillin. Nine patients died (case-fatality rate of 20 percent), but mortality was attributed to pneumonia in only three of them. Main factors associated with a higher mortality were renal failure, absence of cough, an arterial pH <7.3 on admission, ICU hospitalization, shock, mechanical ventilation and an APACHE score >16. Conclusions: The high death rate of these patients could be explained mainly by underlying conditions. ICU management and higher cost preventive measures could reduce this rate (Rev MÚd Chile 2004; 132: 588-94).

Encuesta sobre los métodos de diagnóstico microbiológico de la infección urinaria / Survey on methods for the microbiological diagnosis of urinary tract infection

La infeccióm del tracto urinario (ITU), patología infecciosa altamente prevalente, debe ser confirmada por un diagnóstico microbiológico. El Comité de Microbiología Clínica de la Sociedad Chilena de Infectología realizó una encuesta retrospectiva para conocer la situación actual de algunos laboratorios asistenciales sobre metodología y criterios diagnósticos empleados empleados en el diagnóstico de ITU. Respondieron la encuesta 15 centros hospitalarios y laboratorios privados recopilándose información sobre 49.632 urocultivos. Es destacable que la totalidad de los laboratorios consideraron como criterio microbiológico de ITU un recuento microbiano > 100.000 ufc/ml. No fue posible analizar datos con recuentos inferiores por no disponerse de datos métodos sobre obtención de muestra, resultados del estudio microscópico (sedimiento urinario) concominate y sintomatología clínica. Utilizando este criterio diagnóstico la positividad varió entre 2,3 por ciento en varones y 33 por ciento en mujeres, porcentajes con una mayor dispersión en niños. Sólo 13 por ciento de las intituciones procesaron la muestra de orina en conocimiento del tiempo transcurrido desde la obtención de la muestra. Todos los laboratorios utilizaron el mismo criterio para considerar contaminada una muestra: > 3 microorganismo; algunos de ellos registraron 17 por ciento de contaminación. Si bien esta encuesta fue retrospectiva limitando la calidad del diagnóstico de situación, ella motivó al Comite de Microbiología Clínica a elaborar recomendaciones para el diagnóstico microbiológico de la infección urinaria

Streptococcus pyogenes: susceptibilidad in vitro a diversos antimicrobianos en dos períodos / Streptococcus pyogenes: in vitro susceptibility to several antimicrobials in 2 periods

The frequency of Streptococcus pyogenes infections with deep tissue and toxic shock syndrome has increased in the last decade throughout the world. Aim: to compare antimicrobial susceptibility of S. pyogenes strains isolated during 1986 and 1994-95. Eighty two S. pyogenes strains isolated in 1986 and 67 strains isolated in 1994-1995, were studied. MIC 50 and 90 were determined by an agar dilution method for penicillin, ampicillin, cefazolin, cefuroxime, erythromicin. roxithromycin and miocamycin. Eighty eight strains came from skin of soft tissues, 19 from surgical wounds, 18 from invasive infections, 15 from pharyngeal swabs and 9 from other locations. All strains were susceptible to penicillin, ampicillin, cefazolin, cefuroxime, roxithromycin and miocamycin. Ninety nine percent of strains were susceptibel to erythromycin. Strains isolated in 1994-95 had a higher MIC 50 and 90 for erythromycin than those isolated in 1986. The changes in susceptibility to erythromycin of recently isolated strains could be due to the widespread use of macrolides in Chile

Estudio molecular de 6 episodios de infección intrahospitalaria causados por staphylococcus aureus meticilino-resistente / Molecular study of 6 episodes of intrahospitalary infection due to methicillin resistant staphylococcus aureus

A critical step in any epidemiologic research concerning nosocomial infections is the precise identification of the responsible pathogen. The present work utilized a molecular approach-plasmids identification, restriction lengght polymorphism DNA analysis and random amplified polymorphic DNA for the characterization of 6 nosocomial outbreaks due to 52 strains of methicillin-resistant staphylococcus aureus (MRSA). In these episodes, the clinic-epidemiologic and phenotipic analysis (antibiotype) pointed to a nosocomial infection. Through molecular analysis it was possible to establish in a very precise way, clonality due to MRSA strains in 2 of the studied outbreaks; the same type of analysis allowed to eliminate a MRSA clonal origin in the remainder 4 episodes. The antibiogram was not an useful analytic tool due to its poor discriminatory power. Also, through a PCR procedure, it was possible to identify the presence of the gen mecA in every of the 52 MRSA strains studied

Biología molecular y su aplicación al estudio de las infecciones intrahospitalarias / Molecular biology in the study of nosocomial infections

El objetivo de esta revisión es enfatizar la importancia de la biología molecular de los ácidos nucleicos, en el estudio de las infecciones nosocomiales. Un aspecto importante en este tipo de estudios, es identificar y demostrar clonalidad del agente responsable. Se describe brevemente las técnicas de la biología molecular ya clásica y más relevantes, incluyendo procedimientos basados en la reacción en cadena de la DNA polimerasa y su aplicación a la epidemiología molecular de las enfermedades infecciosas. Se proporciona algunas directrices para seleccionar un procedimiento particular de acuerdo a su aplicabilidad; poder de discriminación reproductibilidad, tiempo y costo

Caracterización genómica de cepas clínicas de candida spp mediante amplificación aleatoria de fragmentos de DNA / Genomic characterization of clinical strains of candida spp by random amplified polymorphic DNA

La incidencia de candidiasis sistémica se ha incrementado en asociación a la sobrevida de pacientes neutropénicos. El diagnóstico precoz presenta limitaciones debido a la baja sensibilidad y especificidad de los métodos diagnósticos en uso; esto explica que el diagnóstico y tratamiento se basan en muchos casos en la sospecha clínica. El tratamiento de la candidiasis sistémica no es siempre exitoso y presenta una alta incidencia de reacciones adversas y complicaciones. En la actualidad, la profilaxis constituye la medida más importante para disminuir la morbimortalidad de eta infección, sin embargo, para establecer medidas eficaces de control, es necesario ahondar en la epidemiología de las infecciones por Candida spp, lo que requiere de sistemas adecuados de caracterización de cepas involucradas. Este estudio presenta los resultados obtenidos mediante el procedimiento denominado amplificación aleatoria de fragmentos de DNA (RAPD-PCR) utilizado como un método de análisis espidemiológico molecular

Primogénitos urbanos: características en el Area Metropolitana Occidente / Urban first borns: characteristics in the west metropolitan area

Para precisar algunas características importantes en salud se encuestaron, en las 72 horas postparto, las madres de 627 primogénitos nacidos en el Hospital San Juan de Dios, de Santiago Occidente, entre diciembre de 1988 y abril de 1989. El 13,1% de las madres fueron menores de 18 años y sólo el 7,4% eran mayores de 35 años. El 96,2% de las madres y 91,2% de los padres tenían más de 4 años de escolaridad. El 48,6% de las madres eran casadas y el 15,8% eran convivientes. La proporción de solteras (35,6%) mostró tendencia a disminuir al aumentar la edad. Hubo un 23,3% de nacidos vivos por cesárea y un 14,7% por fórceps. Se registró un 0,2% de niños con peso de nacimiento bajo 1.500 g; un 7,3% con peso inferior a 2.500 g y un 4,0% de 4.000 g y más. La sensación de apoyo familiar sentida por las madres se midió mediante la prueba de Apgar de Smilkstein. Los puntajes más bajos (0 a 6 puntos), fueron más frecuentes en madres que vivían separadas del padre, pero manteniendo relaciones con él (21,8%). Se concluye que aunque el área biológica es relativamente satisfactoria en los aspectos explorados, el área sociológica presenta problemas de importancia derivados del estado civil y de la sensación de apoyo familiar deficiente

Manejo de los sistemas de drenaje pleural / Management of pleural drainage systems

El amplio uso de los drenajes pleurales en las diversas patologías del tórax (neumotórax, hemotórax, síndrome de ocupación pleural, etc.) implica el buen conocimiento de los sistemas de drenaje aspirativos y no aspirativos. Sus complicaciones están dadas por la infección, la obstrucción, la hemorragia y la filtración. Para un buen manejo del drenaje pleural es importante capacitar al personal, mantener el sistema bajo asepsia rigurosa y si el procedimiento no funciona, cambiar todo el sistema, incluído el tubo de drenaje pleural