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La endocarditis infecciosa es un proceso inflamatorio infeccioso causado por distintos microorganismos afectando el endocardio. Es una entidad poco frecuente en niños previamente sanos; no obstante, no es rara su ocurrencia en niños con ciertas cardiopatías congénitas; encontrándose un aumento en la incidencia en los extremos de las edades pediátricas. Objetivo: Describir las características clínicas y epidemiológicas de los pacientes pediátricos hospitalizados en el Hospital Universitario de Caracas, durante el período comprendido entre enero 2001 a diciembre 2020. Metodología: Estudio descriptivo y retrospectivo, utilizando como criterio de inclusión todo paciente pediátrico entre 0-12 años que ingresa con el diagnóstico de endocarditis infecciosa. Se recolectaron datos como edad, sexo, nivel socioeconómico, comorbilidades, factores predisponentes, hallazgos clínicos, paraclínicos, ecocardiográficos y terapéutica indicada; analizándose con estadística descriptiva, con el fin de establecer tablas de distribución de frecuencias. Resultados: Se incluyeron 17 pacientes en el estudio; el género masculino, los recién nacidos y preescolares fueron los que desarrollaron mayormente esta patología, observándose una supervivencia del 70,8 %. El principal factor predisponente para su desarrollo fue la presencia de catéter venoso central. En el 42,9 % de los hemocultivos se aisló Candida spp. Conclusión: En endocarditis infecciosa, a pesar de su baja incidencia, las complicaciones y mortalidad pueden ser altas; por lo cual ante todo paciente portador de catéter venoso central, con clínica de fiebre, taquicardia y soplo cardíaco, con hallazgos paraclínicos de leucocitosis, anemia y elevación de reactantes de fase aguda se sugiere el descarte de la misma.
Infective endocarditis is an infectious inflammatory process caused by different microorganisms affecting the endocardium. It is a rare entity in previously healthy children; however, its occurrence in children with certain congenital heart diseases is not uncommon; finding an increase in incidence at the extremes of pediatric ages. Objective: To describe the clinical and epidemiological characteristics of pediatric patients hospitalized at the Hospital Universitario de Caracas, during the period from January 2001 to December 2020. Method: Descriptive and retrospective study, using as inclusion criteria all pediatric patients between 0-12 years of age who are admitted with the diagnosis of infective endocarditis. Data such as age, sex, socioeconomic level, comorbidities, predisposing factors, clinical, paraclinical, echocardiographic findings, and indicated therapy were collected; being analyzed with descriptive statistics, in order to establish frequency distribution tables. Results: 17 patients were included in the study, the male gender, the newborns and preschoolers were the ones who developed this pathology with survival of 70.8 %. The main predisposing factor for its development was the presence of central venous catheter. Candida spp was isolated in 42.9 % of blood cultures. Conclusion: In infective endocarditis, despite having low incidence, complications and mortality can be high; therefore, in all patients with a central venous catheter, with symptoms of fever, tachycardia and heart murmur, with paraclinical findings of leukocytosis, anemia and elevation of acute phase reactants, it is suggested to discard it.
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Numerous reports of neuropsychiatric symptoms highlighted the pathologic potential of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its relationship the onset and/or exacerbation of mental disease. However, coronavirus disease 2019 (COVID-19) treatments, themselves, must be considered as potential catalysts for new-onset neuropsychiatric symptoms in COVID-19 patients. To date, immediate and long-term neuropsychiatric complications following SARS-CoV-2 infection are currently unknown. Here we report on five patients with SARS-CoV-2 infection with possible associated neuropsychiatric involvement, following them clinically until resolution of their symptoms. We will also discuss the contributory roles of chloroquine and dexamethasone in these neuropsychiatric presentations.
Subject(s)
COVID-19 Drug Treatment , COVID-19 , Mental Disorders , COVID-19/complications , Chloroquine/therapeutic use , Humans , Mental Disorders/complications , SARS-CoV-2ABSTRACT
Objetivo: determinar el número de pacientes que desarrollaron una infección postquirúrgica, posibles agentes etiológicos y complicaciones.Métodos : se realizó un estudio retrospectivo observacional que incluye a todos los supervivientes de las cirugías electivas y de emergencia de los servicios de Cirugía I, II y III del Hospital Universitario de Caracas durante el año 2019. Los datos fueron recopilados a través de la revisión de historias médicas. 48 historias cumplieron los criterios de inclusión, en estas se analizaron distintas variables como: días de hospitalización, síntomas, resultados de laboratorio, cultivos microbiológicos y tratamientos. A partir de estas se elaboraron tablas de frecuencia y análisis bivariado (Chi-cuadrado de Pearson) con el programa IBM SPSS Statistics 26.Resultados : la prevalencia de las infecciones postoperatorias fue de 4,69% CI 95% = (2,79-7,16%) en los servicios de Cirugía (I, II y III) del hospital durante el año 2019, la mayoría ocurrieron tras cirugías de emergencia (87,50%) tales como: apendicectomías (45,83%) y colecistectomías (10,41%). Solo al 22,91% de estos pacientes se les realizó cultivo microbiológico donde se encontró:E. coli (10,50%), Enterococcus sp. y Klebsiella pneumoniae (6,24%), Morganella morganii (2,1%) y Streptococcus pneumoniae (2,1%). Conclusión : las infecciones del sitio quirúrgico siguen siendo una de las principales causas de morbi-mortalidad y aumento de la estadía hospitalaria en los servicios de cirugía, son de diversa etiología bacteriana y están mayormente asociadas a cirugías abdominales, de emergencia(AU)
Objective: to determine the number of patients that developed a surgical site infection (SSI), possible etiologic agents and complications.Methods : an observational and retrospective study that includes every patient that underwent and survived a surgical procedure at the general surgery I, II and III services at the University Hospital of Caracas between January and December 2019. The study data were collected through the review of the medical records. 48 medical records that met the inclusion criteria and different variables were analyzed, including: days of hospitalization, symptoms, laboratory results, microbiological cultures and treatments. From those variables, frequency tables and bivariate analysis (Pearson's Chi-Square) were created with the IBM SPSS Statistics 26 program.Results : the SSI prevalence was 4,69% CI 95%= (2,79-7,16%) including the three surgery services (I, II and III) at the University Hospital of Caracas during 2019. Most of these occurred after emergency surgeries (87,50%) among which stand out: appendectomy (45,83%) and cholecystectomies (10,41%). Microbiological cultures were performed only in 22,91% of these patients and the following bacteria were isolated:E. coli (10,50%), Enterococcus sp. plus Klebsiella pneumoniae (6,24%), Morganella morganii (2,1%) and Streptococcus pneumoniae (2,1%). Conclusion : Surgical Site Infection (SSI) continues to be one of the main causes of morbimortality and increased hospital stay in surgical services in the hospital. These infections have a diverse bacterial etiology and are mostly associated with abdominal or emergency surgeries(AU)
Subject(s)
Humans , Male , Female , Surgical Wound Infection/etiology , Hospitals, Teaching , Signs and SymptomsABSTRACT
La osteomielitis es una infección de importancia en la edad pediátrica dado su potencial para ocasionar secuelas que pueden llegar a la incapacidad temporal o permanente e incluso la muerte Objetivo: Describir las características de los pacientes pediátricos con diagnóstico de osteomielitis, hospitalizados entre 2013 y 2018 en el Hospital Universitario de Caracas. Métodos: Se realizó un estudio transversal, retrospectivo, descriptivo, se incluyeron los pacientes con el diagnóstico de osteomielitis que cumplieron los criterios de inclusión, analizados los datos mediante frecuencia, porcentaje, media y desviación estándar. Se compararon las variables en los pacientes con osteomielitis crónica y aguda mediante el cálculo de X2 . Resultados: Se encontró predominio masculino, edad promedio de 5,7 años ± 3,5 desviación estándar. La osteomielitis crónica fue más frecuente (68,5 % de los pacientes). La patología de base con mayor predisposición fue la drepanocitosis. El factor de riesgo más importante fue traumatismos. Las manifestaciones clínicas más comunes fueron la fiebre y el dolor. Los huesos más afectados: tibia (27,8 %) y fémur (20,4 %) de los casos. El microorganismo predominante fue Staphylococcus aureus en 31,5 % de los casos, tanto en la osteomielitis aguda como en la crónica, siendo meticilino resistente en 16,3 % de los aislamientos. El tratamiento antibiótico indicado fue combinado. El 94 % de los pacientes egresaron con buena evolución, no se registraron muertes. Conclusiones: Es importante sospechar tempranamente la osteomielitis, tomando conciencia de las manifestaciones clínicas, para agilizar los estudios diagnósticos que contribuyan a iniciar tratamiento precoz, y mejorar el pronóstico de los pacientes
Objective: To describe the characteristics of the pediatric hospitalized patients with diagnosis of osteomyelitis between 2013 and 2018 in the Hospital Universitario de Caracas. Methods: A transversal, retrospective, descriptive study was performed, in which every patient with diagnosis of acute and chronic osteomyelitis who met with all the inclusion criteria, were included. All data was collected in an instrument, designed for that matter, and then was analyzed with frequency, percentages, mean and standard deviation. Variables were compared in acute and chronic osteomyelitis with X2 calculation. Results: Male predominance was found, and average age between 5.7 years ± 3.5 standard deviation. Chronic osteomyelitis was the most frequent (68.5 % of all cases). The most predisposing underlying pathology was sickle cell disease. The most important risk factor was trauma. The most common clinical manifestations were fever and pain in both study groups. The most affected bones: tibia in 27.8 % and femur in 20.4 % of patients. The predominant microorganism was Staphylococcus aureus in 31.5 % of the cases, both in acute and chronic osteomyelitis, being methicillin resistant in 16.3 % of the isolates and in 23.3 % methicilline sensitive. The antibiotic treatment indicated in most cases was combined, followed by surgical treatment. 94 % of the patients were discharged with good outcome, no deaths were registered. Conclusions: The early suspicion of osteomyelitis is important, becoming aware of the clinical manifestations, so as to promptly apply the ideal diagnostic method and contribute to early treatment, in this way improve the patients' prognosis.
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La malaria es una de las enfermedades metaxénicas más importantes en la actualidad y en Venezuela, constituye la mayor epidemia del siglo XXI en la región de las Américas. Este trabajo tiene como objetivo determinar la prevalencia de casos de malaria en Playa Colorada, Estado Sucre, diagnosticados durante la jornada de trabajo de Campamento Universitario Multidisciplinario de Investigación y Servicio de la Universidad Central de Venezuela (CUMIS UCV) y comparar la utilidad diagnóstica de la prueba rápida SD Bioline Malaria Ag P.f/P.f/P.v. Estudio epidemiológico, observacional, descriptivo, de corte transversal y correlacional, realizado en 29 pacientes, entre el 22 y 24 de junio del año 2019. Se obtuvo una prevalencia de 1,05 % con respecto a los pacientes totales de la jornada, lo cual representa un 31 % de casos confirmados de malaria en los pacientes incluidos en el estudio. Las pruebas rápidas para malaria sólo reportaron un falso positivo y ningún falso negativo con respecto a la gota gruesa y extendido. A pesar de que el Estado Sucre constituye uno de los principales contribuyentes de casos de malaria en el país, la prevalencia reportada en este estudio fue baja, posiblemente debido a múltiples factores como las infecciones asintomáticas y submicroscópicas en zonas endémicas. Se recomienda el despistaje de pacientes asintomáticos y la utilización de métodos de diagnóstico molecular al momento de planificar estrategias de control de infecciones
Malaria is one of the most important metaxenic diseases today and in Venezuela, it constitutes the largest epidemic of the 21st century in the region of the Americas. The objective of this work is to determine the prevalence of malaria cases in Playa Colorada, Sucre state, diagnosed during the Multidisciplinary University Camp for Research and Service of the Central University of Venezuela (CUMIS UCV) field trip and to compare the diagnostic utility of the SD Bioline Malaria Ag P.f/P.f/P.v rapid test. Epidemiological, observational, descriptive, cross-sectional and correlational study, carried out in 29 patients, between June 22 and 24, 2019. A prevalence of 1.05 % was obtained with respect to total day patients, which represents 31 % of confirmed cases of malaria in the patients included in the study. Rapid tests for malaria reported only one false positive and no false negatives for the thick and thin blood smear. Despite the fact that Sucre state constitutes one of the main contributors of malaria cases in the country, the prevalence reported in this study was low, possibly due to multiple factors such as asymptomatic and submicroscopic infections in endemic areas. Screening of asymptomatic patients and the use of molecular diagnostic methods is recommended when planning infection control strategies
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Background: The deterioration of Venezuela's health system in recent years undoubtedly contributes to an increased impact of the COVID-19 pandemic. Understanding healthcare workers' (HCWs) knowledge, attitudes, and practices (KAPs) toward COVID-19 in the early stages of the pandemic could inform their medical training and improve their preparedness. Methods: A online national cross-sectional survey was conducted between May 26th and May 30th, 2020, to assess KAPs among HCWs in Venezuela. Results: A total of 1,441 HCWs from all 24 regions of the country responded to the survey. The mean age of the HCWs was 44 (SD [standard deviation] 14) years; most were women (66.4%). Most HCWs were specialized doctors (48%), followed by nurses (13%) and resident doctors (12.3%). The majority of HCWs had good knowledge (76.3%), obtained information mainly from scientific literature (85.4%); had negative attitudes (53.6%), felt uncomfortable with their work during the current pandemic (59.8%); and reported appropriate practices (76.9%). However, participation in COVID-19 related training was absent in more than half of the HCWs. Positive attitudes were significantly more frequent in frontline workers than in non-frontline workers (p = 0.001). Bioanalysts, students, and doctors were more likely to have good knowledge; participating in training was a predictor for positive attitudes and older age was an appropriate practice predictor. Conclusions: HCWs, knowledge in Venezuela could be improved by strengthening education and training programs. Strategies should focus on reducing fear and improving attitudes toward the care of COVID-19 patients, as well as the promotion of preventive practices.
Subject(s)
COVID-19 , Adolescent , Aged , Cross-Sectional Studies , Female , Health Knowledge, Attitudes, Practice , Health Personnel , Humans , Pandemics , SARS-CoV-2 , Surveys and Questionnaires , VenezuelaABSTRACT
Alrededor del 80 % de los casos sintomáticos de COVID-19 tienen una enfermedad leve a moderada, que no suele progresar a fases más avanzadas. El 14 % de los casos pueden progresar en unos 7 a 10 días a un cuadro severo pulmonar, mientras que un 6 % siguen deteriorándose en el tiempo ante una respuesta hiperinflamatoria o de tormenta de citoquinas, que conlleva a shock y falla de múltiples órganos. En general tienen mayor riesgo de progresión los individuos con factores de riesgo como edad mayor de 60 años, género masculino, obesidad, diabetes, hipertensión, inmunosupresión, trasplante de órganos sólidos, enfermedad renal, tabaquismo; pero eso no descarta la posibilidad aislada que individuos aparentemente sanos puedan presentar una evolución severa o diversas complicaciones pulmonares, renales, cardiovasculares, neurológicas, endocrinológicas, entre otras. Este consenso busca orientar al personal de salud en Venezuela en el abordaje terapéutico y la atención de las personas con COVID-19, estableciendo recomendaciones con base a la mejor evidencia para la fecha. Las recomendaciones no solo se limitan a definir qué opciones terapéuticas han mostrado mayor eficacia y seguridad, sino que determina cuáles drogas carecen todavía de suficiente evidencia, y qué alternativas no deberían utilizarse por carecer de beneficios y/o de seguridad establecida. La medicina basada en la evidencia busca fundamentar las decisiones clínicas con base en evidencias; que son todos los elementos y hechos que demuestran jerárquicamente el nivel de veracidad y validez de diversos planteamientos en medicina. El mayor nivel de evidencia terapéutica se construye por medio de metaanálisis y revisiones sistemáticas de la literatura con base en estudios clínicos controlados, prospectivos, con asignación al azar por doble ciego, y con una muestra lo suficientemente importante; y es este tipo de evidencia la que se ha considerado más relevante para establecer las recomendaciones.
About 80 % of symptomatic COVID-19 cases have mild to moderate illness, which does not usually progress to more advanced stages. 14 % of cases can progress in about 7 to 10 days to a severe pulmonary condition, while 6 % continue to deteriorate over time in the face of a hyperinflammatory response or cytokine storm, which leads to shock and failure of multiple organs. In general, individuals with risk factors such as age over 60 years, male gender, obesity, diabetes, hypertension, immunosuppression, solid organ transplantation, kidney disease, smoking, generally have a higher risk of progression. but that does not rule out the isolated possibility that apparently healthy individuals may present a severe evolution or various pulmonary, renal, cardiovascular, neurological, endocrinological complications, among others. This consensus seeks to guide health personnel in Venezuela in the therapeutic approach and care of people with COVID-19, establishing recommendations based on the best evidence to date. The recommendations are not only limited to defining which therapeutic options have shown greater efficacy and safety, but also determine which drugs still lack sufficient evidence, and which alternatives should not be used due to lack of benefits and / or established safety. Evidence-based medicine seeks to base evidencebased clinical decisions; which are all the elements and facts that hierarchically demonstrate the level of veracity and validity of various approaches in medicine. The highest level of therapeutic evidence is constructed through meta-analysis and systematic reviews of the literature based on controlled, prospective clinical studies, with double-blind randomization, and with a sufficiently large sample; and it is this type of evidence that has been considered most relevant to establish the recommendations.
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Introducción: La higiene de manos es un paso fundamental para prevenir la transmisión y diseminación de infecciones asociadas a la atención en salud (IAAS), por esto, es de vital importancia su correcta ejecución según los 5 momentos sugeridos por la Organización Mundial de la Salud (OMS). Objetivo: Aislar bacterias y hongos posterior a la higiene de las manos en el personal de salud. Métodos: Estudio descriptivo, experimental, transversal, con una muestra de 16 individuos que laboraban en el Servicio de Enfermedades Infecciosas del Adulto del Hospital Universitario de Caracas, divididos en dos grupos de 8 participantes, quienes realizaron la higiene de manos de acuerdo a las técnicas descritas por la Organización Mundial de la Salud con agua y jabón (grupo A) y con gel antibacterial a base de alcohol al 70 % (grupo B). Consecutivamente, se tomó muestra de las manos mediante aposición en placas de Petri, en Agar Endo (HiMedia™) y Agar Sabouraud (Oxoid™). Los crecimientos positivos fueron repicados a otros agares y se realizaron pruebas bioquímicas para su identificación. Resultados: En 56,25 % (9/16) de las muestras hubo crecimiento de levaduras, a partir de las cuales se identificaron C. parapsilosis (77,7 %), C. tropicalis (11,3 %) y C. kefyr (11,3 %). Por su parte, 50 % (8/16) tuvieron crecimiento positivo para bacilos Gram negativos fermentadores y no fermentadores. Conclusiones: En las manos de los trabajadores de salud se aislaron bacilos Gram negativos fermentadores y no fermentadores, así como especies de Candida. Se observó una mayor eficacia antimicrobiana con el uso de agua y jabón líquido con respecto a la eliminación de Candida spp.
Introduction: Hand washing is a key tool to prevent transmission and dissemination of hospital associated infections; thus it is a very important to elaborate the proper technique to achieve hand antisepsis, throughout several methods including the 5 times to hand washing proposed by World Health Organization (WHO). Aim: To isolate bacteria and fungi after handwashing in a group of healthcare personnel. Methods: This was an experimental, descriptive and cross-sectional study carried out with 16 healthcare personnel from the Adult Infectious Disease Department at the Hospital Universitario de Caracas, divided in 2 groups (A and B) of 8 participants who was asked and instructed to performed the handwashing technique stablished by the WHO. Group A used conventional soap and water, while group B used 70 % alcohol-based hand sanitizer. After hand sanitization with any of both substances, sample collection was performed throughout hand apposition in Petri dishes with Endo agar (HiMedia™) and Sabouraud dextrose agar with chloramphenicol (Oxoid™) and incubated during 36h in an aerobic 37 °C atmosphere. Positive growth in each case was replied and biochemical tests were performed to each isolation to confirm its identification. Results: 56.25 % (9/16) of the growth was represented by Candida sp: C. parapsilosis (77.7 %), C. tropicalis (11.33 %) and C. kefyr (11.3 %). About bacteria, 50 % (8/16) of the samples collected had growth for gram negative fermenting and nonfermenting bacilli. Conclusions: There were presence of gram-negative bacilli and fungi after handwashing in the hands of the healthcare personnel studied. It was observed that water and soap had a better antimicrobial outcome in comparison with alcohol-based sanitizer to eliminate Candida sp.
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Introducción: La práctica de la higiene de manos por el personal de salud es un elemento esencial para prevenir la transmisión de las infecciones asociadas a la atención sanitaria. El objetivo es evaluar el conocimiento, las prácticas y la actitud del personal de salud médico para la higiene de las manos y las condiciones sanitarias mínimas durante la pandemia de COVID-19 en el Hospital Universitario de Caracas, mayo 2020. Metodología: Estudio de corte transversal intrahospitalario. Población: Médicos adjuntos y residentes, y estudiantes presentes al momento de la visita al Hospital Universitario de Caracas. Instrumentos: Entrevistas, cuestionarios, inspecciones y observaciones del lavado de las manos en trabajo intrahospitalario. Análisis estadístico. Programa SPSS 21 para las estadísticas descriptivas con tablas de distribuciones de frecuencia, promedios, porcentajes, desviaciones estándar y percentiles. Pruebas de Chi2 con límites de confianza del 95 %. Resultados: 42 autocuestionarios, 32 a adjuntos y residentes, 75,6 % jóvenes menores de 30 años y 59 % femeninos. Conocimiento suficiente 74 %, las prácticas auto reportadas el 69 % correctas, y la actitud positiva 87 %. 51 áreas inspeccionadas con fallas de agua 16 %, lavamanos funcionales en 28 % de los ambientes, y falta de jabón, gel alcoholado o toallas desechables. 59 % de los baños para pacientes en malas condiciones sanitarias. Observaciones de higiene de manos durante el acto médico (100 momentos), solo 9 % correctos. La inspección del área de triaje de COVID-19 muestra que se cumplen con lavado de manos con gel alcoholado. La inspección del hospital (OMS) reporta 95 puntos nivel de higiene inadecuado con prácticas de HM y promoción deficientes. Formulario inspección de la OMS ante la COVID-19 arroja fallas en infraestructura, insumos y disponibilidad de EPP y falta de auditorías. Discusión: El conocimiento y las prácticas en puntajes moderados requieren educación médica continua, y la actitud muy positiva del personal de salud permitirán mejorar las prácticas en el lugar de trabajo, siempre que se disponga de la infraestructura, agua y jabón, y de gel alcoholado para el cumplimiento del lavado de las manos en los 5 momentos del acto médico. Conclusión: El hospital requiere mejoras importantes de la infraestructura y la entrega de materiales para la correcta higiene de las manos.
Background: The practice of correct hand hygiene by health workers is a key element in the prevention of health care associated infections. The aim of the study is to assess the knowledge, practice and attitudes of the medical staff on hand hygiene and the minimum sanitary conditions during the COVID-19 pandemic at the Hospital Universitario de Caracas during May 2020. Methods: Transversal study based at the Hospital. Population: medical staff, residents, and medical students present when the inspection team visited the Hospital Universitario de Caracas. Instruments: interviews, questionnaires, inspection and observation of the hand hygiene process during hospital work. Statistical analysis: SPSS 21 software for the descriptive statistics, with frequency distribution tables average, percentage, standard deviation and percentiles. Chi2 test with 95 % confidence limits. Results: 42 self-administered questionnaires, 32 to medical staff and residents, 75,6 % were less than 30 years old and 59 % were female. 74 % had sufficient knowledge, correct self reported practice 69 %, positive attitude 87 %. 51 inspected areas, water failure 16 %, working sinks in 28 % of the areas, lack of soap, alcoholic gel or paper towels. 59 % of patient toilet facilities in bad sanitary conditions. Observations of hand hygiene procedures during medical work (100 moments) were only 9 % correct. Inspection of the COVID-19 triage area showed proper alcoholic gel hand hygiene. Hospital inspection (WHO) reported 95 inadequate hygiene points with deficient hand hygiene and promotion. WHO COVID-19 Inspection Form showed infrastructure failures, lack of supplies and availability of PPE and lack of audits. Discussion: Knowledge and practice had moderate scores which require intervention on the continuous medical education. The staff's positive attitude will allow improvement of practices at the workplace whenever infrastructure and supplies are available, especially soap and water or alcoholic gel, for the 5 moment hand hygiene protocol compliance. Conclusion: The hospital requires important infrastructure and supplies improvements for this purpose.
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A 51 years old female patient with granulomatous mastitis diagnosis, was referred to the Medical Mycology Department "Dr. Dante Borelli" at the Instituto de Medicina Tropical, Universidad Central de Venezuela (IMT-UCV). Mycological diagnosis demonstrated the presence of intracellular yeast structures suggesting Histoplasma sp. and also multi-budding structures compatible with Paracoccidioides sp. To the best of our knowledge, this is the first case report of a granulomatous mastitits due to coinfection of both fungi. 2012 Elsevier Ltd. All rights reserved.
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Abstract Objective: To determine the prevalence of nasal septum perforation associated to Histoplasma sp. Material and Methods: A retrospective descriptive study was conducted with patients who developed nasal septum perforation associated to histoplasmosis. The diagnosis was made based on clinical manifestations and confirmed with mycological direct examination with Giemsa stain, culture, serologic tests (immunodiffusion method), and histopathology with hematoxylin-eosin, Grocott methenamine (GMS) and Periodic Acid-Schiff stain (PAS). Results: Out of 1654 medical records reviewed with diagnosis of histoplasmosis in the study period, we found 22 cases with nasal septum perforation. Autoimmune disease was present in 6 patients; all six were on immunosuppressive treatment. Two patients had HIV/AIDS, one of them had also paracoccidiodomycoses and the remaining had no apparent underlying disease or conditions. Conclusion: Physicians of endemic areas such as Venezuela, must consider this entity in the differential diagnosis with other diseases.
Subject(s)
Humans , Male , Female , Acquired Immunodeficiency Syndrome/pathology , Diagnosis, Differential , Nasal Septal Perforation/diagnostic imaging , Immunosuppressive Agents/therapeutic use , Mycoses/pathology , Autoimmune Diseases/pathology , Venezuela/epidemiology , Medical Records , Epidemiology, Descriptive , Retrospective StudiesABSTRACT
Consenso acerca de los aspectos epidemiológicos, clínicos, terapéuticos y preventivos más importantes de la Difteria
Consensus about the most important epidemiological, clinical, therapeutic and preventive aspects of Diphtheria
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Objective: To identify, using phenotypic methods, FGNB, NFGNB and Candida sp. in toothbrushes, and environmental samples of bathroom air in a group of students from the Dentistry School of the Universidad Central de Venezuela. Material and Methods: Thirty-four toothbrushes were supplied to the cohort during a 60-day period; environmental samples were collected in the rooms where toothbrushes were kept during this period. All samples were processed by traditional methods of microbiological counting isolation and phenotypic identification using selective and differential agar based on the international guidelines of the United States Pharmacopeia (USP) 38. Results: 82.36% of the toothbrush samples were positive to bacteria and fungi and 91.17% of the environmental samples were positive to enterobacteria. Conclusion: It is necessary to establish antiseptic protocols for the management, storage and disinfection of toothbrushes. The high rate of contamination may represent an opportunity for enterobacteria colonization of oral biofilms, reservoir to infection foci and metastatic infections in certain populations.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Toothbrushing , Microbiological Techniques , Environmental Pollution , Enterobacteriaceae , Gram-Negative Bacteria/immunology , Students, Dental , Venezuela , Cross-Sectional StudiesABSTRACT
Objective: To determine the frequency and clinical forms of oral manifestations associated to Paracoccidioidomycosis (PCM) and Histoplasmosis. Material and Methods: 481 medical records of outpatients referred to the Medical Mycology Department were reviewed since 2009 to 2016. Data were analyzed using descriptive statistical methods. Results: 47 (9.77%) cases had oral manifestations, 29 (61.70%) were associated to PCM and 18 (38.29%) to histoplasmosis. For PCM, male-female ratio was 8:1 and 1:1 for histoplasmosis. The average age for PCM was 48 years old and 53 for histoplasmosis. All the PCM patients had more than 1 oral structure affected: 44.82% were gingival lesions and 27.58% palate. In patients with histoplasmosis, 6 (33.33%) were lesions affecting palate and 6 (33.33%) involving tongue. For both entities, painful ulcers and granulomatous-like lesions were the most prevalent clinical forms; however, we observed a wide range of other oral manifestations. Regarding PCM patient's comorbidities, 3 (10.34%) cases had HIV/AIDS, 8 (27.58%) histoplasmosis and 2 (6.89%) carcinomas. Whereas the comorbidities of patients with histoplasmosis, 2 (11.11%) had HIV/AIDS and 1 (5.55%) had carcinoma. Conclusion: In endemic countries for both mycoses, dentists must be aware of patients with mouth lesions, take advantage of epidemiologic clues that suggest risk factors and be acquainted with all the current diagnostic tests in order to make a quick diagnosis and treatment in highly suspicious cases.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Oral Manifestations , Paracoccidioidomycosis/diagnosis , Histoplasmosis/diagnosis , Histoplasmosis/etiology , Mycoses/diagnosis , Retrospective Studies , Data Interpretation, StatisticalABSTRACT
Objetivo: describir las causas de morbilidad, mortalidad y de falla antirretroviral y relacionarlo con el mecanismo de adquisición del virus en adolescentes con VIH / SIDA atendidos en el Hospital Universitario de Caracas, período 2009 - 2013. Métodos: Estudio descriptivo de tipo retrospectivo a través del seguimiento de una cohorte. Se recolectaron los datos de las historias clínicas de pacientes con infección por VIH/SIDA con edades comprendidas entre 10 y 19 años del Hospital Universitario de Caracas durante el período 2009 - 2013. Resultados: se analizaron 79 historias y registros, según el mecanismo de transmisión, 29 (36,71 %) fueron de transmisión vertical (TV) y 50 (63,29 %) de transmisión horizontal (TH). La principal enfermedad oportunista encontrada fue tuberculosis, y no se encontró diferencias significativas para padecerla según el mecanismo de transmisión (p: 0,54). Al considerar los factores demográficos y diagnóstico inicial se observó que a una mayor edad de diagnóstico hay menor probabilidad de falla antirretroviral (OR: 0,75). Así mismo, independientemente del mecanismo de transmisión, sexo y tratamiento inicial el 50% de los pacientes presentará falla virológica luego de 90 meses de tratamiento. Discusión: el aumento en el número de casos de VIH en la población adolescente en Venezuela es un tema de relevancia en Salud Pública. Se necesita realizar un estudio en donde se apliquen estrategias dirigidas a mejorar las causas asociadas a la poca adherencia a los medicamentos antirretrovirales en esta población y determinar si dicha estrategia permite disminuir el número de fallas.
Objective: To describe the causes of morbidity, mortality and antiretroviral failure and to relate them to the mechanism of acquisition of the virus in adolescents with HIV / AIDS treated at the Hospital Universitario de Caracas, in the period 2009 - 2013. Methods: Descriptive, retrospective analysis of the follow up of a cohort. Data from patient with HIV / AIDS aged between 10 and 19 years of the Hospital Universitario de Caracas during the period 2009 - 2013. Results: 79 records were analyzed, according to the transmission mechanism 29 (36.7%) acquired the virus by vertical transmission and 50 (63.2%) by horizontal transmission. The main opportunistic disease was tuberculosis, and no significant differences were found to have it according to the transmission mechanism (p: 0.54). When considering demographic factors and initial diagnosis it was observed that when diagnosis was made at older age there were less probability of antiretroviral failure (OR: 0.75). Also, 50% of patients presented virologic failure after 90 months of treatment independently of the transmission mechanism, gender or type of initial treatment. Discussion: The increase in the number of HIV cases in the adolescent population in Venezuela is a major issue in public health. It is important to study which strategies can improve poor adherence to antiretroviral drugs in this population and to determine whether this strategy can decrease the number of failures.
Subject(s)
Humans , Male , Female , Adolescent , Mortality , HIV , Antiretroviral Therapy, Highly Active , Venezuela , Epidemiology, Descriptive , Morbidity , Hospitals, UniversityABSTRACT
La histoplasmosis es una enfermedad granulomatosa, producida por Histoplasma capsulatum. Causa un amplio espectro de manifestaciones clínicas, la más frecuente es la pulmonar. En algunos casos se presentan formas diseminadas, con afectación de uno o múltiples órganos, con características atípicas, difíciles de reconocer. Reporte del caso: Se presenta el caso de un paciente masculino de 70 años de edad, procedente de Barinas, quien trabajó en una granja de gallinas, con diagnóstico de histoplasmosis y anemia hemolítica, las cuales se resolvieron con tratamiento antifúngico. Conclusiones: En Venezuela, zona endémica para esta micosis, el médico está obligado a tener un alto índice de sospecha acerca de la misma, teniendo en cuenta factores como la edad y la epidemiología. A la luz de nuestros conocimientos, es el tercer caso reportado.
Histoplasmosis is a granulomatous disease, produced by Histoplasma capsulatum. This fungus causes a wide range of clinical manifestations; the most common is the pulmonary form. In some cases, atypical presentations are described. Case report: a 70 year old male patient, from Barinas, Venezuela, who worked in a chicken farm, with diagnosis of histoplasmosis and hemolytic anemia is described. The patient improved with antifungal treatment. Conclusions: in Venezuela, an endemic area for this mycosis, clinicians must have a high suspicion index for this disease, taking into account risk factors, such as age and epidemiology. To our knowledge, this is the third case report in the literature.
ABSTRACT
La histoplasmosis es una enfermedad granulomatosa, producida por Histoplasma capsulatum. Causa un amplio espectro de manifestaciones clínicas, la más frecuente es la pulmonar. En algunos casos se presentan formas diseminadas con afectación de uno o múltiples órganos, de características atípicas difíciles de reconocer. La patogenia de esta enfermedad es igual a la de tuberculosis y se ha descrito coinfección. Se reportan tres casos de histoplasmosis de presentación infrecuente: ancianos, coinfección con micobacterias, localizaciones atípicas y revisión de la literatura. El primer caso fue el de un paciente de 19 años de edad con absceso cerebral. El segundo y tercer caso correspondieron a personas mayores de 60 años, con coinfección por Histoplasma capsulatum y Mycobacterium sp, de presentación articular y enfermedad ginecológica, respectivamente. En Venezuela, zona endémica para esta micosis, el médico está obligado a tener un alto índice de sospecha acerca de la misma, teniendo en cuenta factores como la edad y la epidemiología. (Acta Med Colomb 2015; 40: 254-259).
Histoplasmosis is a granulomatous disease caused by Histoplasma capsulatum. It causes a wide spectrum of clinical manifestations, being the pulmonary the most common one. In some cases disseminated forms with involvement of one or multiple organs are manifested with atypical characteristics difficult to recognize. The pathogenesis of this disease is equal to that of TB and co-infection has been described. Three cases of infrequent presentation of histoplasmosis: elderly, co-infection with mycobacteria, atypical presentations and review of the literature are presented. The first case involved a 19-year-old with cerebral abscess. The second and third cases were for people over 60, co-infected with Histoplasma capsulatum and Mycobacterium sp, with joint involvement and gynecological disease, respectively. In Venezuela, endemic area for histoplasmosis, the doctor is required to have a high index of suspicion about this entity, taking into account factors such as age and epidemiology. (Acta Med Colomb 2015; 40: 254-259).
Subject(s)
Humans , Male , Female , Histoplasmosis , Tuberculosis , Brain Abscess , Arthritis, Infectious , Itraconazole , Nontuberculous Mycobacteria , Mycobacterium tuberculosisABSTRACT
La paracoccidioidomicosis (PCM) es una enfermedad crónica, sistémica, granulomatosa, endémica en nuestro país, producida por un hongo dimorfo denominado Paracoccidioides brasiliensis. Existen numerosas técnicas para realizar el diagnóstico de esta entidad. Nos planteamos la posibilidad de realizar un estudio para determinar la concordancia que pudiese existir entre las diferentes técnicas que se utilizan para el diagnóstico de la PCM. Se realizó un registro de historias clínicas. Se evaluaron 251 historias clínicas de pacientes con diagnóstico de PCM, de la consulta externa de la Sección de Micología Médica Dr. Dante Borelli del IMT-UCV, entre los años 2000 y 2010. Se determinó la concordancia entre los métodos diagnósticos por medio del análisis de concordancia de atributos para datos binarios. Entre el examen directo y el cultivo, no hubo acuerdo. Entre la serología y el examen directo, se encontró que hubo equivalencia, así como entre el cultivo y la serología. No se pudo calcular correlación alguna con la histopatología, ya que no hubo datos negativos, en vista de que todas las muestras procesadas fueron positivas. El diagnóstico de la PCM se basa en la identificación y el aislamiento del hongo. Es obligatoria la realización del examen directo en fresco de toda muestra clínica. Nuestro estudio de muestra que deben realizarse todos los métodos que estén al alcance (examen directo en fresco, cultivo, serología, histopatología) a fin de aumentar la probabilidad de llegar a un diagnóstico certero de esta patología
Paracoccidioidomycosis (PCM) is a chronic, granulomatous disease, endemic in our country, produced by a dimorphic fungus, Paracoccidioides brasiliensis. Several techniques are used for the diagnosis. A study was performed to determine the agreement that could exist between the different techniques, used for the diagnosis of PCM. Clinical records of patients with diagnosis of PCM was made. 251 clinical records were reviewed, from the Sección de Micología Médica Dr. Dante Borelli, IMT- UCV, between 2000 and 2010. The agreement between the methods was determined by means of the analysis of agreement of attributes for binary data. Between direct examination and culture, there was no agreement. Between serology and direct examination, there was equivalence, as well as between culture and serology. Correlation could not be calculated with histopathology, since there were no negative data, due to the fact that all the processed samples were positive. The diagnosis of the PCM is based on the identification and isolation of the fungus. Direct examination is mandatory in all clinical samples. Our study demonstrates that all the methods must be performed (direct examination, culture, serology, histopathology) in order to increase the probability of reaching an accurate diagnosis
Subject(s)
Humans , Diagnostic Techniques and Procedures , Medical Examination/methods , Mycology/methods , Paracoccidioidomycosis/diagnosis , Serology/methods , Infectious Disease MedicineABSTRACT
Describir las características clínico epidemiológicasy estrategias diagnóstico-terapéuticas, asociadas a infección por Histoplasma capsulatum en el Hospital Universitario de Caracas. Estudio descriptivo, retrospectivo y de cohorte. Se realizó la recolección de datos de las historias clínicas de los pacientes con diagnóstico de infección por Histoplasma capsulatum del Hospital Universitario de Caracas durante los años 1999-2009. De 105 pacientes estudiados, se evidencia que predomina el grupo etario de 22 a 46 años, 77,1% son hombres, 49,5% tienen hábito tabáquico, 7,6% se relacionó con construcciones y remodelaciones. La fiebre fue la manifestación clínica más frecuente 84,8%. El diagnóstico se realizó mediante serología en 56,2%, y las muestras biológicas procesadas en mayor número fueron sangre y médula ósea con 49,5%. La presentación más frecuente fue la histoplasmosis diseminada. El tratamiento fue con anfotericina B e itraconazol, la mayoría de los pacientes evolucionaron hacia la mejoría. La histoplasmosis es la infección oportunista endémica más frecuente, especialmente en pacientes con VIH-SIDA,la serología fue el método de diagnóstico de mayor rendimiento. El tratamiento con anfotericina B e itraconazol fue el preferido, la mayoría de los pacientes mejoró. Es importante el estudio de las enfermedades endémicas en nuestros pacientes, especialmente aquellos con VIH-SIDA
To describe the clinical and epidemiological characteristics and diagnostic-therapeutic strategies associated with Histoplasma capsulatum infection at the University Hospital of Caracas. A descriptive, retrospective cohort study. We performed a data collection from medical records of patients diagnosed with Histoplasma capsulatum infection at Caracas University Hospital during the years 1999-2009. Of 105 patients studied, the predominant age group was 22-46 years old, 77.1% male, 49.5% had smoking habits, 7.6% were related to construction and renovation. Fever was the most common clinical manifestation 84.8%. The diagnosis was made by serology in 56.2%, and biological samples processed in highest number were blood and bone marrow with 49.5%. The most common presentation was disseminated histoplasmosis. The preferred treatment was amphotericin B and itraconazole, most patients evolved toward improvement. Histoplasmosis is the most common endemic opportunistic infection, especially in patients with HIV-AIDS; serology was the main diagnostic method. Treatment with amphotericin B and itraconazole was preferred, most of the patients improved. It is important to study endemic diseases in our patients, especially those with HIV-AIDS