Bone involvement in non-congenital syphilis / Compromiso óseo por sífilis no congénita

We documented two stages of bone involvement due to syphilis in two adult patients infected with human immunodeficiency virus. Bony lesions of secondary versus tertiary syphilis cannot be differentiated on clinical or radiologic grounds alone. Given the rarity of this clinical presentation, there is no consensus on treatment duration and related outcomes.

Se describen dos etapas de compromiso óseo por sífilis en dos pacientes adultos infectados por el virus de la inmunodeficiencia humana. Las lesiones óseas de la sífilis secundaria y de la sífilis terciaria no se pueden diferenciar únicamente por características clínicas o radiológicas. Dada la rareza de esta presentación clínica, no hay consenso sobre la duración del tratamiento y los resultados relacionados.

Bone involvement in non-congenital syphilis / Compromiso óseo por sífilis no congénita

We documented two stages of bone involvement due to syphilis in two adult patients infected with human immunodeficiency virus. Bony lesions of secondary versus tertiary syphilis cannot be differentiated on clinical or radiologic grounds alone. Given the rarity of this clinical presentation, there is no consensus on treatment duration and related outcomes.

Se describen dos etapas de compromiso óseo por sífilis en dos pacientes adultos infectados por el virus de la inmunodeficiencia humana. Las lesiones óseas de la sífilis secundaria y de la sífilis terciaria no se pueden diferenciar únicamente por características clínicas o radiológicas. Dada la rareza de esta presentación clínica, no hay consenso sobre la duración del tratamiento y los resultados relacionados.

Acute Q Fever With Dermatologic Manifestations, Molecular Diagnosis, and No Seroconversion.

We herein described a case of acute infection by Coxiella burnetii (acute Q fever) that started with a short incubation period and showed prominent dermatological manifestations and unusual serological behavior. The infection was confirmed by molecular detection through real-time polymerase chain reaction using genomic DNA collected from peripheral blood.

Rhinosporidiosis in the Americas: A Systematic Review of Native Cases.

Rhinosporidiosis is a chronic mucosal infection caused by Rhinosporidium seeberi, an aquatic protistan parasite. It presents as nasal or ocular polypoidal or vascularized masses. It is endemic in tropical and subtropical areas, especially in South Asia; R. seeberi´s endemicity in the Americas is often overlooked. The objective of this study was to describe the demographic and clinical characteristics of patients with rhinosporidiosis in the Americas, its management, and patient outcomes. This study is a systematic review of cases of human rhinosporidiosis in the Americas reported in the literature from 1896 to February 28, 2019. This review screened 1,994 reports, of which 115 were eligible for further analysis. The selected reports described 286 cases of human rhinosporidiosis between 1896 and 2019. Cases were diagnosed in Brazil (32.2%), Colombia (24.4%), Paraguay (12.6%), and the United States (11.9%). The majority of the cases (91%) occurred in geographic areas with altitudes < 1,000 m above sea level and in areas with median temperatures ≥ 25°C (67.3%). Most of the patients presented nasal (65%) and ocular involvement (35%). Surgical treatment was provided for 99.6% of patients, but 19.8% of them recurred. This review describes the under-recognized geographic distribution and clinical presentation of rhinosporidiosis in the Americas and highlights clinical differences to cases in Asia, specifically in reference to a higher prevalence of ocular disease and higher relapse rates.

Outcomes and complications of hospitalised patients with HIV-TB co-infection.

BACKGROUND: Tuberculosis is one of the most common causes of hospitalisation in patients with HIV. Despite this, hospital outcomes of patients with this co-infection have rarely been described since antiretroviral therapy became widely available. METHODS: Prospective cohort study of HIV-infected adult patients hospitalised with TB in six referral hospitals in Medellin, Colombia, from August 2014 to July 2015. RESULTS: Among 128 HIV-infected patients hospitalised with tuberculosis, the mean age was 38.4 years; 79.7% were men. HIV was diagnosed on admission in 28.9% of patients. The median CD4 + T-cell count was 125 (±158 SD) cells/µL. Only 47.3% of patients with a known diagnosis of HIV upon admission were on antiretroviral therapy, and only 11.1% had a tuberculin skin test in the previous year. Drug toxicity due to tuberculosis medications occurred in 11.7% of patients. Mean length of stay was 23.2 days, and 10.7% of patients were readmitted. Mortality was 5.5%. CONCLUSIONS: Hospital mortality attributable to tuberculosis in patients with HIV is low in reference hospitals in Colombia. Cases of tuberculosis in HIV-infected patients occur mainly in patients with advanced HIV, or not on antiretroviral therapy, despite a known diagnosis of HIV. Only one of every 10 patients in this cohort had active screening for latent tuberculosis, possibly reflecting missed treatment opportunities.

CONTEXTE: La tuberculose (TB) est l'une des causes les plus courantes d'hospitalisation chez les patients VIH positifs. Malgré cela, les résultats hospitaliers des patients atteints de cette coinfection ont rarement été décrits depuis que le traitement antirétroviral est devenu largement disponible. MÉTHODES: Etude de cohorte prospective de patients adultes infectés par le VIH hospitalisés pour TB dans six hôpitaux de référence à Medellin, en Colombie, d'août 2014 à juillet 2015. RÉSULTATS: Sur 128 patients infectés par le VIH hospitalisés pour TB, l'âge moyen était de 38,4 ans; 79,7% étaient des hommes. Le VIH a été diagnostiqué à l'admission chez 28,9% des patients. Le nombre médian de lymphocytes T CD4+ était de 125 (±158 SD) cellules/µL. Seuls 47,3% des patients dont le diagnostic de VIH était connu lors de leur admission étaient sous traitement antirétroviral et 11,1% seulement avaient subi un test cutané à la tuberculine l'année précédente. Une toxicité médicamenteuse due aux médicaments antituberculeux est survenue chez 11,7% des patients. La durée moyenne de séjour était de 23,2 jours et 10,7% des patients ont été réadmis. La mortalité était de 5,5%. CONCLUSIONS: La mortalité hospitalière attribuable à la TB chez les patients VIH positifs est faible dans les hôpitaux de référence en Colombie. Les cas de TB chez les patients infectés par le VIH surviennent principalement chez les patients à un stade avancé du VIH, ou qui ne sont pas sous traitement antirétroviral, malgré un diagnostic connu de VIH. Seul un patient sur 10 de cette cohorte a subi un dépistage actif de la TB latente, ce qui reflète peut-être des opportunités de traitement manquées.

Artritis séptica por Streptococcus equi: reporte de un caso y revisión de la literatura / Septic arthritis due to Streptococcus equi: a case report and review of the literatura

En humanos las infecciones producidas por Streptococcus equi son de rara ocurrencia, tienen una amplia variedad de formas de presentación, incluyendo compromiso articular, el cual ha sido pocas veces descrito en humanos y aún menos en pacientes inmunocompetentes. En este artículo se presenta un caso de artritis séptica por S. equi que ocurrió por una exposición ocupacional en un paciente inmunocompetente y la revisión de la literatura relacionada.

Human infections caused by Streptococcus equi are rare, have a wide variety of forms of presentation, including joint involvement, which has been rarely described in humans and even less in immunocompetent patients. In this article we present a septic arthritis case due to S. equi that occurred due to an occupational exposure in an immunocompetent patient, and a review of the related literature as well. The publication of this case report was accepted by the institutional ethics committee and the consent signed by the patient was obtained.

Rhinosporidiosis in Colombia: case series and literature review.

Rhinosporidiosis is a chronic granulomatous disease that affects mucosal surfaces. Its epidemiology and clinical presentation in Colombia are not well-known. We therefore reviewed all 58 reported cases between 1964 and 2015 to raise awareness among clinicians in a non-endemic area. Of the patients, 64% were male (median age = 15 years) and 57% had ocular and 43% nasal manifestations; there were no disseminated cases of the disease. All lesions were surgically removed.

[Sociodemographic and clinical characteristics of patients infected with Leptospira spp. treated at four hospitals in Medellín, Colombia, 2008-2013].

INTRODUCTION: Leptospirosis remains a significant health problem in tropical regions including Latin America, where its presentation is 100 times higher than that observed in other regions of the world. Mortality reaches 10% in severe cases. Its diagnosis is challenging because clinical manifestations during the initial phase are non-specific and because of limited availability of diagnostic tests. OBJECTIVE: To describe the demographic and clinical characteristics and the outcomes in hospitalized patients with leptospirosis. MATERIALS AND METHODS: This retrospective study included patients treated at four institutions in Medellín between January, 2009, and December, 2013, with a compatible clinical picture and a positive IgM for Leptospira spp. RESULTS: We included 119 patients, 80% male, and 58% of rural origin. The mean duration of symptoms was 9.6 days (SD=9.6). Eighty nine per cent of patients had fever; 62%, jaundice; 74%, myalgia; 46%, diarrhea; 41%, hepatomegaly; 13%, splenomegaly, and 13%, conjunctival injection. Fifty four per cent of patients had impaired renal function; 32%, pulmonary compromise, and 13%, liver failure. Sixteen per cent required admission to the ICU; 12%, mechanical ventilation, and 11%, vasopressor therapy.Weil's syndrome occurred in 38.6% and 5% died. The average hospital stay was 11 days (SD=9.6). CONCLUSIONS: In this population, the clinical manifestations and complications of leptospirosis were similar to those reported in the literature. We observed a relatively low overall mortality in relation to global statistics.

Características sociodemográficas y clínicas de pacientes con infección por Leptospira spp. atendidos en cuatro centros hospitalarios de Medellín, Colombia, 2008-2013 / Sociodemographic and clinical characteristics of patients infected with Leptospira spp. treated at four hospitals in Medellín, Colombia, 2008-2013

Resumen Introducción: La leptospirosis continúa siendo un problema significativo de salud en regiones tropicales, incluidos los países de Latinoamérica, donde es 100 veces más frecuente que en otras regiones del mundo. En los cuadros graves de la enfermedad, su mortalidad alcanza el 10 %. Su diagnóstico es un reto debido a que las manifestaciones clínicas en la fase inicial son inespecíficas y a la poca disponibilidad de pruebas diagnósticas. Objetivo: Describir las características sociodemográficas y clínicas, y el desenlace de la enfermedad en pacientes hospitalizados con leptospirosis. Materiales y métodos: Es un estudio retrospectivo que incluyó pacientes atendidos en cuatro instituciones de Medellín, entre enero de 2009 y diciembre de 2013, con un cuadro clínico sugestivo e IgM positiva para Leptospira spp. Resultados: Se incluyeron 119 pacientes, 80 % hombres y 58 % de procedencia rural. La duración promedio de los síntomas fue de 9,6 días (DE=9,6). El 89 % de los pacientes presentó fiebre; el 62 %, ictericia; el 74 %, mialgias; el 46 %, diarrea; el 41 %, hepatomegalia; el 13 %, esplenomegalia, y 13 %, enrojecimiento de los ojos. En 54 % de los pacientes hubo deterioro de la función renal, en 32 %, compromiso pulmonar y, en 13 %, falla hepática. El 16 % de los pacientes requirió atención en la unidad de cuidados intensivos, el 12 %, asistencia respiratoria mecánica, y el 11 %, administración de vasopresores. En 38,6 % de ellos la enfermedad cursó con síndrome de Weil y el 5 % falleció. La duración promedio de la hospitalización fue de 11 días (DE=9,6). Conclusiones:. La leptospirosis en esta población tuvo manifestaciones clínicas y complicaciones similares a las reportadas en la literatura científica. Se observó una mortalidad general relativamente baja comparada con las estadísticas mundiales.

Abstract Introduction: Leptospirosis remains a significant health problem in tropical regions including Latin America, where its presentation is 100 times higher than that observed in other regions of the world. Mortality reaches 10% in severe cases. Its diagnosis is challenging because clinical manifestations during the initial phase are non-specific and because of limited availability of diagnostic tests Objective: To describe the demographic and clinical characteristics and the outcomes in hospitalized patients with leptospirosis. Materials and methods: This retrospective study included patients treated at four institutions in Medellín between January, 2009, and December, 2013, with a compatible clinical picture and a positive IgM for Leptospira spp. Results: We included 119 patients, 80% male, and 58% of rural origin. The mean duration of symptoms was 9.6 days (SD=9.6). Eighty nine per cent of patients had fever; 62%, jaundice; 74%, myalgia; 46%, diarrhea; 41%, hepatomegaly; 13%, splenomegaly, and 13%, conjunctival injection. Fifty four per cent of patients had impaired renal function; 32%, pulmonary compromise, and 13%, liver failure. Sixteen per cent required admission to the ICU; 12%, mechanical ventilation, and 11%, vasopressor therapy. Weil's syndrome occurred in 38.6% and 5% died. The average hospital stay was 11 days (SD=9.6). Conclusions: In this population, the clinical manifestations and complications of leptospirosis were similar to those reported in the literature. We observed a relatively low overall mortality in relation to global statistics.

Osteomielitis por Yokenella regensburgei después de una craneotomía en una paciente inmunocompetente / Osteomyelitis due to Yokenella regensburgei following craniotomy in an immunocompetent patient

Yokenella regensburgei es un bacilo Gram negativo de la familia Enterobacteriaceae, que puede encontrarse en agua de pozos, alimentos y en el tubo digestivo de insectos y reptiles. Aunque se ha aislado de muestras provenientes de seres humanos, pocas veces se ha reportado como causante de infección y, en tales casos, especialmente en pacientes inmunosuprimidos. Se presenta aquí el primer caso de osteomielitis secundaria a una infección por Y. regensburgei en una paciente inmunocompetente después de un procedimiento quirúrgico.

The gram-negative bacillus Yokenella regensburgei (of the Enterobacteriaceae family) can be found in groundwater and foodstuffs, as well as the digestive tracts of insects and reptiles. Although it has been isolated from humans since its original description, it has rarely been reported as a cause of infection, and then, only in immunosuppressed patients. We report the first case of post-surgical secondary osteomyelitis due to Y. regensburgei in an immunocompetent woman who had undergone a craniotomy.

Response to therapy in patients with cryptococcosis and AIDS: association with in vitro susceptibility to fluconazole / Respuesta al tratamiento en pacientes con criptococosis y sida: relación con la sensibilidad in vitro al fluconazol

Background. The implications of the Cryptococcus neoformans resistance to fluconazole on patient therapy have not been fully elucidated due to the discordant results found in published studies. Aims. To establish the influence of C. neoformans resistance to fluconazole in the therapy of individuals with cryptococcosis and AIDS. Methods. This study retrospectively compared the clinical course of patients with cryptococcosis according to the level of fluconazole resistance of their C. neoformans isolates. Results. This study included 71 episodes of cryptococcosis, defined as those isolates of C. neoformans obtained from patients with mycosis, of which 36 isolates were sensitive to fluconazole, 20 susceptible dose-dependent (SDD), and 15 were resistant. There were 5 treatment failures in the consolidation phase; two occurred in patients who had a susceptible strain, 2 in patients who had SDD strains, and one in a patient who had a resistant strain. During the maintenance treatment, relapses occurred in 4 of 33 patients (12%), seen during the follow-up period, none of which occurred in the group with resistant isolates. There were no significant differences in survival time free of treatment failure (p = 0.65) or survival time free of failure or relapse (p = 0.38). These results were not affected when tested in a Cox model that included age, CD4T lymphocyte counts, and use of antiretroviral therapy. Conclusions. In HIV patients with cryptococcosis, the resistance of C. neoformans appeared not to increase the risk of failure or relapse during treatment (AU)

Antecedentes. Las implicaciones de la resistencia de Cryptococcus neoformans al fluconazol en el tratamiento de pacientes infectados con esta levadura no han sido completamente definidas debido a hallazgos discordantes obtenidos previamente. Objetivos. Dilucidar la influencia de la resistencia de C. neoformans al fluconazol en el tratamiento de los pacientes con criptococosis y sida. Métodos. En este estudio se compara retrospectivamente la evolución clínica de los pacientes con criptococosis según el grado de resistencia al fluconazol de los aislamientos de C. neoformans obtenidos de ellos. Resultados. Se incluyeron 71 episodios de criptococosis definidos por el aislamiento de C. neoformans de pacientes con la micosis, que se distribuyeron de la siguiente manera: 36 aislamientos fueron sensibles, 20 sensibles dosis-dependiente y 15 resistentes. En la fase de consolidación, cinco fallos en el proceso de tratamiento tuvieron lugar: dos en pacientes con aislamientos sensibles, dos en pacientes con aislamientos dosis-dependiente y uno en un paciente con un aislamiento resistente. Durante la fase de mantenimiento se presentaron 4 recurrencias en los 33 pacientes que tuvieron seguimiento (12%), ninguna de las cuales ocurrió en el grupo con aislamientos resistentes. No se encontraron diferencias estadísticamente significativas en el tiempo de supervivencia de los casos sin fallo terapéutico (p = 0.65) o en el tiempo de supervivencia de los casos sin fallo terapéutico o recaída (p = 0.38). Estos resultados no se modificaron cuando fueron evaluados en un modelo de regresión de Cox en el que se incluyeron la edad, el conteo de linfocitos T CD4 y el uso de terapia antirretroviral. Conclusiones. En pacientes con VIH y criptococosis la resistencia de C. neoformans a fluconazol parece no incrementar el riesgo de fallo terapéutico o recaída (AU)

Response to therapy in patients with cryptococcosis and AIDS: Association with in vitro susceptibility to fluconazole.

BACKGROUND: The implications of the Cryptococcus neoformans resistance to fluconazole on patient therapy have not been fully elucidated due to the discordant results found in published studies. AIMS: To establish the influence of C. neoformans resistance to fluconazole in the therapy of individuals with cryptococcosis and AIDS. METHODS: This study retrospectively compared the clinical course of patients with cryptococcosis according to the level of fluconazole resistance of their C. neoformans isolates. RESULTS: This study included 71 episodes of cryptococcosis, defined as those isolates of C. neoformans obtained from patients with mycosis, of which 36 isolates were sensitive to fluconazole, 20 susceptible dose-dependent (SDD), and 15 were resistant. There were 5 treatment failures in the consolidation phase; two occurred in patients who had a susceptible strain, 2 in patients who had SDD strains, and one in a patient who had a resistant strain. During the maintenance treatment, relapses occurred in 4 of 33 patients (12%), seen during the follow-up period, none of which occurred in the group with resistant isolates. There were no significant differences in survival time free of treatment failure (p=0.65) or survival time free of failure or relapse (p=0.38). These results were not affected when tested in a Cox model that included age, CD4T lymphocyte counts, and use of antiretroviral therapy. CONCLUSIONS: In HIV patients with cryptococcosis, the resistance of C. neoformans appeared not to increase the risk of failure or relapse during treatment.

[Osteomyelitis due to Yokenella regensburgei following craniotomy in an immunocompetent patient]. / Osteomielitis por Yokenella regensburgei después de una craneotomía en una paciente inmunocompetente.

The gram-negative bacillus Yokenella regensburgei (of the Enterobacteriaceae family) can be found in groundwater and foodstuffs, as well as the digestive tracts of insects and reptiles. Although it has been isolated from humans since its original description, it has rarely been reported as a cause of infection, and then, only in immunosuppressed patients. We report the first case of post-surgical secondary osteomyelitis due to Y. regensburgei in an immunocompetent woman who had undergone a craniotomy.

ANÁLISIS DE BIOMATERIALES PARA USO EN INGENIERÍA DE TEJIDO DE PIEL: REVISIÓN / ANALYSIS OF BIOMATERIALS FOR SKIN TISSUE ENGINEERING: REVIEW / ANÁLISE DE BIOMATERIAIS PARA USO EM ENGENHARIA DE TECIDOS DA PELE: PATCH

La ingeniería de tejidos es un área que ha venido creciendo desde los últimos treinta años con diferentes aplicaciones en piel, hueso, tejido neural, tejido cardiovascular, entre otras. Una de las áreas más trabajadas y de mayores aplicaciones es la relacionada con el tejido de la piel, con importantes avances en el desarrollo de sustitutos. En este trabajo se hace una revisión sobre los biomateriales más usados para desarrollos en el área de ingeniería de tejidos con aplicaciones específicas al tejido de piel. La información obtenida fue clasificada de acuerdo a los biomateriales más usados de origen natural o sintético, y de acuerdo a sus aplicaciones como sustitutos dérmicos, epidérmicos o dermo-epidérmicos. A su vez las ventajas y desventajas de su implementación in vivo o clínica fueron consideradas. Adicionalmente, se presenta una introducción al uso de los nanomateriales en diferentes áreas relacionadas con la ingeniería de tejidos. Según esta revisión, la biocompatibilidad de los materiales naturales es adecuada, al igual que la recepción al momento del injerto, pero su resistencia mecánica es baja. Los materiales sintéticos, por su parte, presentan más alta resistencia mecánica y siguen siendo objeto de investigación para mejorar su biocompatibilidad y controlar su degradación. Dentro del estudio se presentaron los nanomateriales como un área de amplio desarrollo y de alta proyección para su aplicación en ingeniería tisular.

Tissue engineering is a research field that has grown over the last thirty years with different applications in skin, bone, neural tissue and cardiovascular tissue, among others. One of the most studied and promising application relates to the engineering of skin tissue, which has led to important advances in the development of skin substitutes. This work reviews the most used biomaterials for applications in the field of skin tissue engineering. The reviewed literature was classified according to the most used natural or synthetic biomaterials and according to their application as dermal, epidermal, or dermal-epidermal substitutes. At the same time, advantages and disadvantages of their in vivo or clinical implementation were considered. Based on this literature review, the biocompatibility of natural materials is appropriate, as well as their grafting efficiency, but their mechanical strength is low. Synthetic materials, in contrast, show higher mechanical strength and are subject of investigations that seek to improve their biocompatibility and biodegradability. This review also showed that the use of nanomaterials is a very promising research area with excellent prospects for applications in tissue engineering.

Engenharia de tecidos é uma área que tem crescido desde os últimos trinta anos, com diferentes aplicações em pele, osso, tecido neural, tecido cardiovascular, entre outros. Uma das áreas de aplicação mais elaborados e maiores está relacionada com o tecido da pele, com um progresso significativo no desenvolvimento de substitutos. Este trabalho apresenta uma revisão dos biomateriais mais utilizados para desenvolvimentos na área da engenharia de tecidos com aplicações específicas para o tecido da pele. As informações obtidas foram classificadas de acordo aos biomateriais mais utilizados de origem natural ou sintética, e de acordo às suas aplicações como substitutos de pele, epidérmica ou dermo-epidérmica. Por sua vez, as vantagens e desvantagens da sua implementação in vivo ou clínica foram considerados. Além disso uma introdução ao uso de nanomateriais em diferentes áreas relacionadas com a engenharia de tecidos é apresentado. De acordo com esta revisão, a biocompatibilidade de materiais naturais é adequado, como o tempo de recepção da enxertia, mas a sua resistência mecânica é baixa. Os materiais sintéticos, por sua vez, tem alta resistência mecânica e ainda estão sob investigação para melhorar a sua biocompatibilidade e controle de degradação. Dentro deste estudo apresentaram-se os nanomateriais como um área de desenvolvimento global e alta projeção para uso em engenharia de tecidos.

Histoplasmosis en Colombia: resultados de la encuesta nacional, 1992-2008 / Histoplasmosis: results of the Colombian National Survey, 1992-2008

Introducción. La histoplasmosis está caracterizada por variadas manifestaciones que van desde la afección subclínica a la enfermedad diseminada, y suele presentarse tanto en huéspedes inmunocompetentes como inmunosuprimidos. Como la enfermedad no es de notificación obligatoria en Colombia, se diseñó una encuesta para recolectar información de los casos diagnosticados en el país. Objetivo. El objetivo de este trabajo fue analizar los datos recolectados desde 1992 hasta 2008. Materiales y métodos. La encuesta incluyó datos demográficos, factores de riesgo, manifestaciones clínicas, estudios de imágenes, métodos diagnósticos y tratamiento antifúngico. Los pacientes se agruparon de acuerdo con los factores de riesgo y se compararon los correspondientes hallazgos.Resultados. Se examinaron 434 encuestas provenientes de 20 de los departamentos colombianos. La mayoría (96,1 %) correspondían a adultos, 77 % eran hombres con edad promedio de 38,4 años, y sólo 3,9 % eran niños o adolescentes. En los adultos, 70,5 % tenían sida y 7 % presentaban otra inmunosupresión. Las manifestaciones predominantes fueron fiebre (76,1 %), tos (54,8 %) y síntomas constitucionales (56,8 %). En las radiografías, las anormalidades fueron principalmente infiltrados (65,9 %) y nódulos (17,1 %). El diagnóstico se estableció por observación microscópica de H. capsulatum en 49,6 % casos, por cultivo en 58 % y por pruebas serológicas en 14,6 %. El tratamiento se informó sólo en 52,5 % casos. Conclusiones. Se demostró que la histoplasmosis es frecuente en Colombia, especialmente en grupos de riesgo como son los pacientes infectados con el VIH. El análisis de este número relevante de pacientes permitió establecer comparaciones válidas sobre aspectos de la histoplasmosis en nuestro país.

Introduction. Histoplasmosis, a fungal disorder characterized by a wide spectrum of manifestations that range from subclinical infections to disseminated processes, affects both immunocompetent and immunosuppressed individuals. Histoplasmosis is not a reportable disease in Colombia and consequently, a survey was designed to collect histoplasmosis cases diagnosed in the country. Objective. The aim of this work was to analyze the data collected from 1992 to 2008. Materials and methods. The survey included demographic data, risk factors, clinical manifestations, imaging data, diagnostic methods and antifungal treatment. Patients were grouped according to risk factors and comparisons of the various findings were done. Results. A total of 434 surveys were gathered from 20 of the country’s Departments. Most patients (96.1%) were adults, 77% were males with a mean age of 38.4 years. Only 3.9% were children less than 15 years of age. In the adult population, AIDS was reported in 70.5% of the cases; additionally, in 7.0% patients other immunosuppressive conditions were informed. The most frequent clinical manifestations were fever (76.1%), cough (54.8%) and constitutional symptoms (56.8%). X rays abnormalities were represented mainly by infiltrates (65.9%) and nodules (17.1%). Diagnosis was made by microscopic observation of H. capsulatum in 49.6% patients, by culture in 58.0% and by serological test in 14.6% cases. Antifungal use was recorded in 52.5% cases. Conclusions. Histoplasmosis is frequent in Colombia, especially in certain risk factor groups such as the HIV-infected population. Data collected from this large number of cases has allowed valid comparisons on various aspects of histoplasmosis in Colombia.

Histoplasmosis: results of the Colombian national survey, 1992-2008.

INTRODUCTION: Histoplasmosis, a fungal disorder characterized by a wide spectrum of manifestations that range from subclinical infections to disseminated processes, affects both immunocompetent and immunosuppressed individuals. Histoplasmosis is not a reportable disease in Colombia and consequently, a survey was designed to collect histoplasmosis cases diagnosed in the country. OBJECTIVE: The aim of this work was to analyze the data collected from 1992 to 2008. Materials and methods. The survey included demographic data, risk factors, clinical manifestations, imaging data, diagnostic methods and antifungal treatment. Patients were grouped according to risk factors and comparisons of the various findings were done. RESULTS: A total of 434 surveys were gathered from 20 of the country's Departments. Most patients (96.1%) were adults, 77% were males with a mean age of 38.4 years. Only 3.9% were children less than 15 years of age. In the adult population, AIDS was reported in 70.5% of the cases; additionally, in 7.0% patients other immunosuppressive conditions were informed. The most frequent clinical manifestations were fever (76.1%), cough (54.8%) and constitutional symptoms (56.8%). X rays abnormalities were represented mainly by infiltrates (65.9%) and nodules (17.1%). Diagnosis was made by microscopic observation of H. capsulatum in 49.6% patients, by culture in 58.0% and by serological test in 14.6% cases. Antifungal use was recorded in 52.5% cases. CONCLUSIONS: Histoplasmosis is frequent in Colombia, especially in certain risk factor groups such as the HIV-infected population. Data collected from this large number of cases has allowed valid comparisons on various aspects of histoplasmosis in Colombia.

Caracterización de los pacientes con sospecha de aspergilosis invasiva estudiados con prueba Platelia Aspergillus® / Characterization of patients with suspected invasive aspergillosis studied by Platelia test

Objetivo: describir las características de los pacientes en los que se realizó prueba Platelia Aspergillus® por sospecha de AI, y los resultados de la prueba según las categorías diagnósticas. Metodología: se revisaron retrospectivamente las historias clínicas de pacientes con sospecha de AI atendidos en instituciones de salud de Medellín a quienes se les realizó la prueba Platelia Aspergillus®. Se colectaron y analizaron de manera descriptiva los datos clínicos, imaginológicos, microbiológicos y los resultados de la prueba Platelia Aspergillus®. Resultados: se incluyeron 78 pacientes atendidos entre 2006- 2008. Se diagnosticó AI en 21 (26.9%) pacientes, colonización en ocho (10.3%) pacientes. La forma pulmonar invasiva aguda se encontró en 17 (81.0%), forma diseminada en tres (14.3%). La fiebre y la disnea fueron la principal manifestación. En la tomografía de pulmón se observaron más frecuentemente nódulos pulmonares. La prueba fue positiva en 31 (39.7%) pacientes, en 50% de los pacientes colonizados. En 17 (47.2%) de los 36 pacientes recibieron antibióticos betalactámicos, la prueba fue positivo. Conclusiones: la AI puede encontrarse hasta en la tercera parte de pacientes con sospecha clínica; sin embargo, el diagnóstico es difícil debido al cuadro clínico inespecífico, además de las dificultades para obtener muestras clínicas y al pobre rendimientode las pruebas diagnósticas.

Objective: to describe the characteristics of patients with suspected IA, who were studied with the platelia test as well as theresults according to different diagnostic categories. Methods: the medical records of patients with suspected IA treated at health facilities in Medellin who were tested with platelia were retrospectively reviewed. Clinical data, imaging, microbiology and the platelia test results were collected and descriptively analyzed. Results: we included 78 patients treated from 2006 to 2008. IA was diagnosed in 21 (26.9%) patients and colonization was found in 8 (10.3%) patients. The acute invasive pulmonary form was found in 17 (81.0%), disseminated form in three (14.3%). Fever and dyspnea were the principal manifestation. Nodules were found more frequently in lung tomography. The tests were positive in 31 (39.7%) patients and in 50% of colonized patients. In 17 (47.2%) of 36 patients who received beta-lactamantibiotics, the test showed a positive result. Conclusions: IA can be found in up to one third of patients with clinical suspicion, but diagnosis remains difficult because of the nonspecific clinical picture, coupled with the difficulty for obtaining clinical samples and the poor performance of diagnostic tests.

Identification of Paracoccidioides brasiliensis in adrenal glands biopsies of two patients with paracoccidioidomycosis and adrenal insufficiency.

The authors report two cases of adrenal insufficiency secondary to infiltration of the adrenal glands by Paracoccidioides brasiliensis. The first patient had been treated for a chronic multifocal form of paracoccidiodomycosis 11 years ago. The diagnosis of the mycosis was done simultaneous with that of the adrenal insufficiency in the second patient. In both patients the diagnosis was done by direct visualization of fungus in adrenal biopsies. They were treated with hormonal supplements and itraconazol by 12 and six months, without relapses during the follow-up period.

Identification of Paracoccidioides brasiliensis in adrenal glands biopsies of two patients with paracoccidioidomycosis and adrenal insufficiency / Identificação do Paracoccidioides brasiliensis nas amostras de glândulas adrenais de dois doentes com paracoccidioidomicose e insuficiência adrenal

The authors report two cases of adrenal insufficiency secondary to infiltration of the adrenal glands by Paracoccidioides brasiliensis. The first patient had been treated for a chronic multifocal form of paracoccidiodomycosis 11 years ago. The diagnosis of the mycosis was done simultaneous with that of the adrenal insufficiency in the second patient. In both patients the diagnosis was done by direct visualization of fungus in adrenal biopsies. They were treated with hormonal supplements and itraconazol by 12 and six months, without relapses during the follow-up period.

Os autores apresentam dois casos de insuficiência supra-renal secundária à infiltração das adrenais pelo Paracoccidioides brasiliensis. O primeiro paciente tinha sido tratado de paracoccidioidomicose crônica multifocal 11 anos atrás. No segundo paciente, o diagnóstico da micose foi feito de forma simultânea com o da insuficiência adrenal. Em ambos os pacientes, o diagnóstico foi feito pela visualização direta do fungo nas biopsias adrenais. Eles foram tratados com suplementos hormonais com itraconazol por seis a 12 meses, sem recaídas durante o período de acompanhamento.