[Can preterm birth be prevented from ascending bacterial infection and its adverse results in the public hospitals of Chile?] / ¿Se puede prevenir el parto prematuro por infección bacteriana ascendente y sus resultados adversos en los hospitales públicos de Chile?

Preterm birth (PB) is the main contributor to the perinatal morbidity/mortality. In spite of the knowledge of the risk factors and the introduction of medical interventions intended to prevent PB, its frequency has increased. Ascending bacterial infection (ABI) is the obstetric condition most frequently associated to PB causing an important adverse perinatal outcome in a public hospital in Chile. This review shows the association between PB and ABI, analyzes the physiopathology and immunology of vaginal infections in the susceptible pregnant woman., as well as their application in this group of effective measures demonstrated by evidence, such as routine control, treatment of genitourinary tract infections (GTI), prophylactic or therapeutic cerclage, use of probiotics, use of vaginal progesterone, metabolic control of diabetes mellitus and weight of the obese woman. Treatment GTI together with the use of medical interventions that improve the vaginal immunity in the risk population allow to predict a reduction of PB by ABI and of its immediate consequences, long term sequels and high associated costs, with the consequent benefit of the public health in Chile.

¿Se puede prevenir el parto prematuro por infección bacteriana ascendente y sus resultados adversos en los hospitales públicos de Chile? / Can preterm birth be prevented from ascending bacterial infection and its adverse results in the public hospitals of Chile?

Resumen El parto prematuro (PP) es el principal contribuyente de la morbilidad/mortalidad perinatal. A pesar del conocimiento de los factores de riesgo y de la introducción de intervenciones médicas destinadas a la prevención del nacimiento prematuro, su frecuencia ha aumentado. La infección bacteriana ascendente (IBA) es la condición obstétrica más frecuente asociada al PP ocasionando un importante resultado perinatal adverso en un hospital público de Chile. Esta revisión muestra la asociación entre PP e IBA, analiza la fisiopatología y la inmunología de las infecciones vaginales en la mujer embarazada susceptible, como asimismo la aplicación en este grupo de medidas con evidencia clínica que han demostrado ser eficientes, tales como la pesquisa rutinaria y el tratamiento de las infecciones genitourinarias (IGU), el cerclaje profiláctico o terapéutico, uso de probióticos, de progesterona vaginal, control metabólico de la diabetes mellitus y del peso de la obesa. El tratamiento de las IGU, conjuntamente con el uso de intervenciones que mejoran la inmunidad vaginal en la población de riesgo, permiten predecir una reducción del PP por IBA, de sus consecuencias inmediatas y de largo plazo y costos asociados elevados, con el consiguiente beneficio de la salud pública de Chile.

Preterm birth (PB) is the main contributor to the perinatal morbidity/mortality. In spite of the knowledge of the risk factors and the introduction of medical interventions intended to prevent PB, its frequency has increased. Ascending bacterial infection (ABI) is the obstetric condition most frequently associated to PB causing an important adverse perinatal outcome in a public hospital in Chile. This review shows the association between PB and ABI, analyzes the physiopathology and immunology of vaginal infections in the susceptible pregnant woman., as well as their application in this group of effective measures demonstrated by evidence, such as routine control, treatment of genitourinary tract infections (GTI), prophylactic or therapeutic cerclage, use of probiotics, use of vaginal progesterone, metabolic control of diabetes mellitus and weight of the obese woman. Treatment GTI together with the use of medical interventions that improve the vaginal immunity in the risk population allow to predict a reduction of PB by ABI and of its immediate consequences, long term sequels and high associated costs, with the consequent benefit of the public health in Chile.

Meningitis neonatal precoz causada por transmisión vertical de Escherichia coli productora de beta-lactamasa de espectro extendido en parto prematuro con rotura prematura de membranas / Early neonatal meningitis caused by vertical transmission of extended-spectrum beta-lactamase-producing Escherichia coli in premature labor with premature rupture of membranes

Se comunica el caso de un recién nacido producto de un parto prematuro con rotura prematura de membranas, que desarrolló precozmente meningitis neonatal por Escherichia coli productora de beta-lactamasa de espectro extendido. Los cultivos en líquido céfalo raquídeo y sangre neonatal fueron tempranamente positivos para esta bacteria. No obstante no aislarse este microorganismo en la madre, los hallazgos de la biopsia placentaria y la precocidad de la infección neonatal son determinantes en señalar que se trató de infección intraamniótica con transmisión vertical al neonato. La meningitis neonatal fue tratada con meropenem y el niño se dio de alta en buenas condiciones después de 41 días de hospitalización. Las guías perinatales actuales, preconizan el tamizaje de muestras vaginales para la prevención del parto prematuro y de los resultados adversos asociados a infección bacteriana ascendente durante el embarazo.

We report the case of a newborn resultant of premature delivery with premature rupture of membranes, which developed early-onset neonatal meningitis caused by transmission of Escherichia coli producer of betalactamasa of spectrum extended. Cultures in cerebrospinal fluid and neonatal blood were early positive for this bacterium. Although this microorganism is not isolated in the mother, the findings of the placenta biopsy and the precocity of the neonatal infection are determinant in indicating that it was an intraamniotic infection with vertical transmission to the neonate. Neonatal meningitis was treated with meropenem and the child was discharged in good condition after 41 days of hospitalization. The current perinatal guidelines support the screening of vaginal samples for the prevention of preterm birth and the adverse outcomes associated with ascending bacterial infection during pregnancy.

[Obesity, a risk factor for ascending bacterial infection during pregnancy]. / Obesidad, factor de riesgo de infección bacteriana ascendente durante el embarazo.

BACKGROUND: Obesity in pregnancy is associated with significantly higher rates of infection. AIM: To compare the infectious morbidity in pregnant women with normal and altered body mass index (BMI). MATERIAL AND METHODS: Cross sectional retrospective study of 6,150 patients who had delivery or second trimester abortion during 2012. The patients were classified according to BMI as underweight, normal weight, overweight and obese. We compared the frequency of pregnancy and perinatal complications related to ascending bacterial infection (ABI). The data was obtained from the hospital’s databases. RESULTS: Obese patients had higher rates of pregnancy and perinatal complications related to ABI compared to patients with normal weight. The odds ratios (OR) and 95% confidence intervals (CI) for second trimester abortion were 3.45 (1.63-7.31) p < 0.01, for preterm delivery 2.42 (1.51-3.87) p < 0.01, for labor and puerperium infections 3.42 (2.06-5.68) p < 0.01 and for early neonatal infectious and perinatal mortality 4.46 (1.75-11.37) p < 0.01. A logistic regression analysis revealed that obesity is an independent risk factor for second trimester abortion related to ABI with an OR of 3.18 (CI 95% 1.46-6.91), premature delivery related to ABI with an OR of 2.51 (CI 95% 1.54-4.09) and for delivery and postpartum infections with an OR of 4.44 (CI 95% 2.62 to 7.51). CONCLUSIONS: Obese pregnant women had a 2.5 to 4.5 times increased risk of infectious morbidity compared to normal weight patients. Obesity is an independent risk factor for second trimester abortion and preterm delivery related to ABI and delivery and postpartum infectious.

Obesidad, factor de riesgo de infección bacteriana ascendente durante el embarazo / Obesity, a risk factor for ascending bacterial infection during pregnancy

Background: Obesity in pregnancy is associated with significantly higher rates of infection. Aim: To compare the infectious morbidity in pregnant women with normal and altered body mass index (BMI). Material and Methods: Cross sectional retrospective study of 6,150 patients who had delivery or second trimester abortion during 2012. The patients were classified according to BMI as underweight, normal weight, overweight and obese. We compared the frequency of pregnancy and perinatal complications related to ascending bacterial infection (ABI). The data was obtained from the hospital’s databases. Results: Obese patients had higher rates of pregnancy and perinatal complications related to ABI compared to patients with normal weight. The odds ratios (OR) and 95% confidence intervals (CI) for second trimester abortion were 3.45 (1.63-7.31) p < 0.01, for preterm delivery 2.42 (1.51-3.87) p < 0.01, for labor and puerperium infections 3.42 (2.06-5.68) p < 0.01 and for early neonatal infectious and perinatal mortality 4.46 (1.75-11.37) p < 0.01. A logistic regression analysis revealed that obesity is an independent risk factor for second trimester abortion related to ABI with an OR of 3.18 (CI 95% 1.46-6.91), premature delivery related to ABI with an OR of 2.51 (CI 95% 1.54-4.09) and for delivery and postpartum infections with an OR of 4.44 (CI 95% 2.62 to 7.51). Conclusions: Obese pregnant women had a 2.5 to 4.5 times increased risk of infectious morbidity compared to normal weight patients. Obesity is an independent risk factor for second trimester abortion and preterm delivery related to ABI and delivery and postpartum infectious.

Ureaplasmas and mycoplasmas in vaginal samples from prepubertal girls and the reasons for gynecological consultation.

OBJECTIVES: The aim of the study was to evaluate vaginal colonization with Ureaplasmaurealyticum (UU) and Mycoplasma hominis (MH) in prepubertal girls and reason for gynecological consultation. PATIENTS AND METHODS: All prepubertal girls sent for consultation for medical issues to a pediatric gynecology department. Vaginal swabs were obtained for culture and were seeded using specific media. Patients colonized with genital mycoplasmas (GMs) were evaluated by a psychologist to rule out sexual abuse (SA). RESULTS: A total of119 patients were included. The mean age was 5.9 y. Reasons for consultation were vulvovaginitis in 78 (66%), SA before study entry in 19 (16%), labial adhesion in 8 (7%), genital bleeding in 8 (7%), suspected sexual abuse in 3 (3%) and 1 patient was sent for consultation for labial adhesion but had a normal examination (1%), physical neglect in 1 (1%), and genital ulcers in 1 (1%). UU was isolated in 14 (12%) MH was isolated in 3 (3%). UU was isolated in 9 patents (47%) with SA before study entry. Five patients colonized with UU that had consulted for other reasons were evaluated by a pediatric psychologist; 4 disclosed SA. One patient colonized with UU did not disclose SA. Patients with GMs were more likely to disclose sexual abuse (UU P < .0001. MH P < .0065). CONCLUSION: GMs were isolated more in SA cases. Patients colonized with GMs and consulted for other issues than SA were more likely to disclose SA.

Efecto de un plan educativo en la capacidad de agencia de autocuidado del paciente con hipertensión arterial en una institución de segundo nivel / Effect of an Educational Plan on the Self-care Management Capacity of Hypertensive Patients at a Second-tier Institution / Efeito de um programa educativo na capacidade de agência de autocuidado do paciente com hipertensão arterial em uma instituição segundo nível

Objetivo: el propósito de este estudio fue determinar el efecto de un plan educativo en la capacidad de agencia de autocuidado del paciente hipertenso en una institución de segundo nivel. Materiales y métodos: se realizó un estudio de intervención pre y postest, con la participación de 83 pacientes con diagnóstico de hipertensión arterial, a quienes se les aplicó el instrumento "Evaluación de la capacidad de agencia de autocuidado en el paciente hipertenso" al inicio del estudio y tres meses posteriores a la implementación del plan educativo. Resultados: el plan educativo mejoró tanto la capacidad de agencia de autocuidado global como sus rangos, encontrando significancia estadística con un valor de probabilidad menor de 0,002 y de 0,0001 respectivamente. Conclusiones: las intervenciones educativas estructuradas a partir de la identificación de las necesidades individuales de información, en conjunto con el empoderamiento del individuo y el seguimiento por parte del profesional de enfermería, permiten alcanzar conductas permanentes de autocuidado que facilitan el autoconocimiento, la modificación del comportamiento así como la adquisición de conocimientos y habilidades.

Objective: The purpose of this study was to determine the effect of an educational plan on the capacity of hypertensive patients at a second-tier institution to manage self-care. Materials and methods: A pre -and post-intervention test was conducted with the participation of 83 patients who had been diagnosed with hypertension. An instrument entitled "Assessment of Self-care Management Capacity among Hypertensive Patients" was applied to this group at the beginning of the study and three months after implementation of the educational plan. Results: The educational plan improved self-care management capacity overall and in the different ranges, showing a statistical significance with a probability value under 0.002 and 0.0001, respectively. Conclusions: Structured educational interventions based on identified individual needs, coupled with individual empowerment and monitoring done by nursing professionals, made it possible to achieve permanent behavior with respect to self-care, facilitating self-knowledge and changes in behavior patterns, in addition to the acquisition of skills and know-how.

Objetivo: o propósito deste artigo foi determinar o efeito de um programa educativo na capacidade de agência de autocuidado do paciente hipertenso em uma instituição de segundo nível. Materiais e métodos: realizou-se um estudo de intervenção pré e pós-teste, com a participação de 83 pacientes com diagnóstico de hipertensão arterial, aos quais se aplicou o instrumento "Avaliação da capacidade de agência de autocuidado no paciente hipertenso" ao início do estudo e três meses posteriores à implementação do programa educativo. Resultados: o programa educativo melhorou tanto a capacidade de agência de autocuidado global quanto suas faixas, constatando significância estatística com um valor de probabilidade menor de 0,002 e de 0,0001, respectivamente. Conclusões: as intervenções educativas estruturadas a partir da identificação das necessidades individuais de informação, em conjunto com o empoderamento do indivíduo e o seguimento por parte do profissional de enfermagem, permitem atingir condutas permanentes de autocuidado que facilitam o autoconhe-cimento, a modificação do comportamento, bem como a aquisição de conhecimentos e habilidades.

Community-acquired pneumonia in Chile: the clinical relevance in the detection of viruses and atypical bacteria.

BACKGROUND: Adult community-acquired pneumonia (CAP) is a relevant worldwide cause of morbidity and mortality, however the aetiology often remains uncertain and the therapy is empirical. We applied conventional and molecular diagnostics to identify viruses and atypical bacteria associated with CAP in Chile. METHODS: We used sputum and blood cultures, IgG/IgM serology and molecular diagnostic techniques (PCR, reverse transcriptase PCR) for detection of classical and atypical bacteria (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumoniae) and respiratory viruses (adenovirus, respiratory syncytial virus (RSV), human metapneumovirus, influenza virus, parainfluenzavirus, rhinovirus, coronavirus) in adults >18 years old presenting with CAP in Santiago from February 2005 to September 2007. Severity was qualified at admission by Fine's pneumonia severity index. RESULTS: Overall detection in 356 enrolled adults were 92 (26%) cases of a single bacterial pathogen, 80 (22%) cases of a single viral pathogen, 60 (17%) cases with mixed bacterial and viral infection and 124 (35%) cases with no identified pathogen. Streptococcus pneumoniae and RSV were the most common bacterial and viral pathogens identified. Infectious agent detection by PCR provided greater sensitivity than conventional techniques. To our surprise, no relationship was observed between clinical severity and sole or coinfections. CONCLUSIONS: The use of molecular diagnostics expanded the detection of viruses and atypical bacteria in adults with CAP, as unique or coinfections. Clinical severity and outcome were independent of the aetiological agents detected.

Self-care agency capacity in Patients with diagnostic of high blood pressure in a second level institution / Capacidad de agencia de autocuidadoen el paciente con hipertensión arterial en una institución de segundo nivel / Capacidade de agencia de autocuidado no paciente com hipertensão arterial em uma instituição de segundo nível

El objetivo de este estudio fue determinar la capacidad de agencia de autocuidado en245 pacientes hipertensos que asistieron a una institución de segundo nivel de atenciónen el 2010, mediante el desarrollo de un estudio descriptivo de tipo transversalcon la aplicación del instrumento Evaluación de la capacidad de agencia de autocuidadoen el paciente hipertenso. Se encontró que el 81,22 % (n = 199) y el 8,16 % (n = 20)de los pacientes presentaron una capacidad de agencia de autocuidado media y bajarespectivamente, y tan solo el 10,61 % (n = 26) de los pacientes presentó una capacidadde agencia de autocuidado alta. Ello indicaría que aunque el paciente con hipertensiónarterial posee algunas habilidades que le permiten discernir acerca de los factores quedebe controlar para promover su salud y su cuidado, son insuficientes para lograr unaadecuada adherencia al tratamiento, ya que para alcanzar un compromiso y participaciónen este, es necesario que existan conductas permanentes de autocuidado quefaciliten el autoconocimiento, el empoderamiento del individuo y el desarrollo de lacapacidad de tomar decisiones sobre su salud. La percepción del paciente de su estadode salud es fundamental para el desarrollo de las capacidades de autocuidado; por esoes fundamental que el profesional de enfermería intervenga de acuerdo con las capacidadesdel individuo, para autocuidarse promoviendo apoyo educativo que le permita alpaciente modificar su comportamiento, adquirir conocimiento y habilidad...

The objective of this study was to determine the self-care ability on 245 hypertensivepatients who attended to a secondary level institution in 2010. This was done by developinga descriptive cross-sectional study with the application of the “Assessmentself-care ability instrument in hypertensive patients” (Evaluación de la capacidad deagencia de autocuidado en el paciente hipertenso). We found that 81.22% (n = 199) and8.16% (n = 20) of the patients presented a medium and low Self-care ability respectively,and only the 10.61% (n = 26) of the patients presented a high self-care ability.This would indicate that, although the patient with hypertension has some abilitiesthat let him/her discern about the factors that he/she should control to promote hishealth and health care, they are insufficient to achieve an adequate adherence to thetreatment. In order to have their commitment and participation, it is necessary to havepermanent self care behaviors to facilitate the self-awareness, the empowerment of theindividual and the development of the capacity to make decisions about their health.The patient's perception of his health is critical to the development of the self careabilities, so it is essential that the nurse intervene in accordance with the individual'scapacities to self-care, by promoting educational support to allow the patient to modifyhis behavior, acquiring knowledge and skill...

O objetivo deste estudo foi determinar a capacidade de agencia de autocuidado em245 pacientes hipertensos que compareceram a uma instituição de segundo nível deatenção em 2010, mediante o desenvolvimento de um estudo descritivo de tipo transversalcom a aplicação do instrumento Avaliação da capacidade de agencia de autocuidadono paciente hipertenso. Encontrou-se que 81,22 % (n = 199) e 8,16 % (n = 20)dos pacientes apresentaram uma capacidade de agencia de autocuidado média e baixarespectivamente, e somente 10,61 % (n = 26) dos pacientes apresentou uma capacidadede agencia de autocuidado alta. Isso indicaria que, o paciente com hipertensãoarterial possui algumas habilidades que lhe permitem discernir sobre os fatores quedeve controlar para promover sua saúde e seu cuidado, são insuficientes para conseguiruma adequada aderência ao tratamento, já que para alcançar um compromisso eparticipação neste, é preciso que existam condutas permanentes de autocuidado quefacilitem o autoconhecimento, o empoderamento do indivíduo e o desenvolvimento dacapacidade de tomar decisões sobre sua saúde. A percepção do paciente de seu estadode saúde é fundamental para o desenvolvimento das capacidades de autocuidado; porisso é fundamental que o profissional de enfermagem intervenha de acordo com as capacidadesdo indivíduo, para autocuidar-se promovendo apoio educativo que permitaao paciente modificar seu comportamento, adquirir conhecimento e habilidade...

Role of neutralizing antibodies in adults with community-acquired pneumonia by respiratory syncytial virus.

BACKGROUND: Respiratory syncytial virus (RSV) has been implicated in the etiology of adult community-acquired pneumonia (CAP). We investigated RSV infection in Chilean adults with CAP using direct viral detection, real-time reverse-transcription polymerase chain reaction (rtRT-PCR), and serology (microneutralization assay). METHODS: RSV, other respiratory viruses, and bacteria were studied by conventional and molecular techniques in adults aged ≥18 years presenting with CAP to the healthcare facilities in Santiago, Chile from February 2005 through December 2007. RESULTS: All 356 adults with CAP enrolled had an acute blood sample collected at enrollment, and 184 had a convalescent blood sample. RSV was detected in 48 cases (13.4%). Immunofluorescence assay and viral isolation each detected only 1 infection (0.2%), whereas rtRT-PCR was positive in 32 (8.9%) cases and serology was positive in 20 (10.8%) cases. CAP clinical characteristics were similar in RSV-infected and non-RSV-infected cases. RSV-specific geometric mean serum-neutralizing antibody titer (GMST) was significantly lower at admission in the 48 RSV-infected cases compared with 308 non-RSV-infected adults (GMST in log(2): RSV/A 8.1 vs 8.9, and RSV/B 9.3 vs 10.4; P < .02). CONCLUSIONS: RSV infection is frequent in Chilean adults with CAP. Microneutralization assay was as sensitive as rtRT-PCR in detecting RSV infection and is a good adjunct assay for diagnostic research. High RSV-specific serum-neutralizing antibody levels were associated with protection against common and severe infection. The development of a vaccine could prevent RSV-related CAP in adults.

[Nugent and Spiegel criteria for the diagnosis of bacterial vaginosis. Analysis of discordant specimens by the Ison and Hay method]. / Comparación de los criterios de Nugent y Spiegel para el diagnóstico de vaginosis bacteriana y análisis de los resultados discordantes por el método de Ison y Hay.

BACKGROUND: Vaginal infection is the commonest cause of genital symptoms and has obstetric and gynecological implications. AIM: To compare the Nugent and Spiegel methods for the diagnosis of bacterial vaginosis (BV) and to analyze discordant specimens using Ison and Hay (Ison/Hay) criteria. MATERIAL AND METHODS: After discarding cases with Candidiasis, deficient specimens or those lacking bacteria, a total of 348 Gram-stained smears vaginal specimens received for the diagnosis of BV, were analyzed. RESULTS: Vaginal microbiota was classified as normal in 203 and 237 samples (58 and 68% of samples), according to Nugent and Spiegel criteria, respectively One hundred and five (30%) and 111 samples (32%), were classified as VB according to Nugent and Spiegel criteria, respectively. Both criteria were concordant in 308 samples (88.5%). The 40 (11.5%) discordant specimens were classified as intermediate microflora by the Nugent system and as normal or BV by Spiegel. Among these, the Ison/Hay procedure identified four categories of microbiota. Ten (25%) specimens were classified as grade II microbiota, confirming their categorization by Nugent as intermediate microbiota, six (15%) were classified in the III category, confirming the diagnosis of BV by Spiegel, 13 (32.5%) corresponded to the category III, that does not exist in the Nugent and Spiegel categorization systems. Finally, 11 specimens could not be assigned to one category due to microscopic limitations to distinguish bacterial morphotypes. CONCLUSIONS: The systems proposed by Spiegel, Nugent and Ison/Hay are comparable for the diagnosis of BV. However, we recommend the use of Ison/Hay procedure to evaluate vaginal microbiota, due to its wider range of categories, allowing a better discrimination of the vaginal microbiota.

Comparación de los criterios de Nugent y Spiegel para el diagnóstico de vaginosis bacteriana y análisis de los resultados discordantes por el método de Ison y Hay / Nugent and Spiegel criteria for the diagnosis of bacterial vaginosis. Analysis of discordant specimens by the Ison and Hay method

Background: Vaginal infection is the commonest cause of genital symptoms and has obstetric and gynecological implications. Aim: To compare the Nugent and Spiegel methods for the diagnosis of bacterial vaginosis (BV) and to analyze discordant specimens using Ison and Hay (Ison/Hay) criteria. Material and Methods: After discardingcases with Candidiasis, deficientspecimens or those lacking bacteria, a total of348 Gram-stained smears vaginal specimens receivedfor the diagnosis of BV, were analyzed. Results: Vaginal microbiota was classified as normal in 203 and 237 samples (58 and 68 percent of samples), accordingto Nugent and Spiegel criteria, respectively One hundred andfive (30 percent) and 111 samples (32 percent), were classified as VB accordingto Nugent and Spiegel criteria, respectively. Both criteria were concordant in 308 samples (88.5 percent). The 40 (11.5 percent) discordant specimens were classified as intermedíate microflora by the Nugent system and as normal or BV by Spiegel. Among these, the Ison/Hay procedure identified four categories of microbiota. Ten (25 percent) specimens were classified as grade II microbiota, confirming their categorization by Nugent as intermedíate microbiota, six (15 percent) were classified in the III category, confirming the diagnosis ofBV by Spiegel, 13 (32.5 percent) corresponded to the category III, that does not exist in the Nugent and Spiegel categorization systems. Finally, 11 specimens could not be assigned to one category due to microscopic limitations to distinguish bacterial morphotypes. Conclusions: The systems proposed by Spiegel, Nugent and Ison I Hay are comparable for the diagnosis of BV. However, we recommend the use of Ison/ Hay procedure to evalúate vaginal microbiota, due to its wider range of categories, allowing a better discrimination ofthe vaginal microbiota.

[Serotypes and antimicrobial susceptibility of Streptococcus agalactiae]. / Serotipos y susceptibilidad antimicrobiana de Streptococcus agalactiae.

BACKGROUND: Streptococcus agalactiae or group B streptococcus, GBS, is the leading cause of neonatal and maternal infections and an opportunistic pathogen in adults with underlying disease. In the last decade, a dramatic increase in the resistance of this microorganism to erythromycin and clindamycin has been observed. AIM: To determine the serotype distribution and antimicrobial susceptibility of isolates of S. agalactiae collected from infections and colonization and to assess the genetic mechanisms of macrolide and clindamycin resistance. MATERIAL AND METHODS: A total of 100 GBS isolates were collected between 1998 and 2002, in Santiago, Chile. They were isolated from the amniotic fluid from patients with premature rupture of membranes (7 isolates), blood from neonatal sepsis (10 isolates), neonate colonizations (2 strains), skin and soft tissue infections (7 isolates), urinary tract infections (5 isolates), genital infections (3 isolates), articular fluid (one isolate), and 65 strains were recovered from vaginal colonization55. RESULTS: Serotypes Ia, II and III were the predominant serotypes identified in our study, accounting for 90 (90%) of the strains. Five isolates belonged to serotypes Ib (5%) and two (2%) to serotype V respectively; no strains belonging to serotype IV were found. All strains were susceptible to penicillin G, ampicillin and cefotaxime, and four isolates (4%) were resistant to both erythromycin (MIC >64 microg/ml) and clindamycin (MIC >64 microg/ml). The strains had a constitutive macrolide-lincosamide-streptogramin (cMLSB) resistance phenotype and the erm(A) gene was present in the four isolates. CONCLUSIONS: Serotypes Ia, II and III were the predominant serotypes in this study. All strains were susceptible to penicillin G, ampicillin and cefotaxime, and four (4%) strains were resistant to both erythromycin and clindamycin. The cMLSB resistance phenotype, and the erm(A) gene was detected in resistant strains.

[Community acquired pneumonia in a hospitalized community: etiological study]. / Neumonía adquirida en la comunidad que se hospitaliza: estudio etiológico.

BACKGROUND: Community-acquired pneumonia (CAP) that requires hospitalization, is a common and serious disease. A permanent assessment in specialized centers, to define therapeutic guidelines according to local epidemiological factors, is mandatory. AIM: To study the etiology of CAP requiring hospital admission. PATIENTS AND METHODS: Adult patients with CAP, admitted to the Clinical Hospital of the University of Chile between 1999 and 2001 were studied. A clinical, radiological and microbiological assessment was done in all patients. Blood and sputum cultures and serology for Chlamydia and Mycoplasma pneumoniae were performed. RESULTS: Thirty one patients aged 62 +/- 18 years, 12 female, met inclusion criteria. An etiologic diagnosis was made in 74% of cases, (52% definitive, 22% probable). Frequency of definitive diagnosis was: 25% Mycoplasma pneumoniae, 19% Chlamydia pneumoniae and 13% Streptococcus pneumoniae. Mixed etiology was found in 16% and a final diagnosis was not obtained in 26% of the cases. No correlation was found between clinical and radiological patterns, and the etiologic agent. C reactive protein and erythrosedimentation rate were significantly higher in CAP due to Chlamydia and Streptococcus pneumoniae. CONCLUSIONS: The higher frequency of Mycoplasma and Chlamydia pneumoniae, than previously reported, suggests that atypical agents should be considered in the initial antimicrobial therapy prescribed to these patients.

Chlamydophila psittaci: detección de anticuerpos en palomas de vida libre (Columba livia doméstica) en la ciudad de Santiago, Chile / Chlamydophila psittaci: antibodies in free-living pigeons (Columba livia domestica) of Santiago, Chile

Un total de 92 sueros de palomas (Columba livia doméstica) capturadas en la ciudad de Santiago durante 1999 fueron evaluados para determinar la presencia de anticuerpos contra Chlamydophila psittaci (C. psittaci) mediante inmunofluorescencia indirecta (IFI). Trece de las 92 aves analizadas (14,1 por ciento), presentaron títulos de IgG específicos para C. psittaci > 32, punto de corte considerado específico para IFI. Debido a que las palomas no mostraban signos clínicos de clamidiosis aviar, los títulos de anticuerpos se atribuyen a exposición previa o bien, infección asintomática

Chlamydophila psittaci: detección de anticuerpos en palomas de vida libre (Columba livia doméstica) en la ciudad de Santiago, Chile / Chlamydophila psittaci: antibodies in free-living pigeons (Columba livia domestica) of Santiago, Chile

Un total de 92 sueros de palomas (Columba livia doméstica) capturadas en la ciudad de Santiago durante 1999 fueron evaluados para determinar la presencia de anticuerpos contra Chlamydophila psittaci (C. psittaci) mediante inmunofluorescencia indirecta (IFI). Trece de las 92 aves analizadas (14,1 por ciento), presentaron títulos de IgG específicos para C. psittaci > 32, punto de corte considerado específico para IFI. Debido a que las palomas no mostraban signos clínicos de clamidiosis aviar, los títulos de anticuerpos se atribuyen a exposición previa o bien, infección asintomática (AU)

Flora microbiana genital en embarazadas con y sin riesgo de infección / Genital microbial flora in pregnant women with and without infection risk

Objetivos: existe importante evidencia, que relaciona la infección del tracto genital inferior de la mujer y particularmente vaginosis bacteriana con parto prematuro e infección materna neonatal. El objetivo de este estudio fue conocer la prevalencia de la flora microbiana aislada en la infección cérvicovaginal y las relaciones microbiológicas existentes en una población de embarazadas con y sin riesgo de desarrollar infección génito urinaria. Diseño del estudio: se admitieron embarazadas con y sin riesgo de infección génitourinaria. La condición de riesgo se consideró según criterios establecidos previamente. Tres muestras cérvicovaginales fueron tomadas a todas las pacientes para conocer la microbiología de cérvix y vagina. Resultados: se enrolaron 156 mujeres, 82 con riesgo y 74 sin riesgo. Los microorganismos que se aislaron más frecuentemente en el grupo con riesgo fueron staphylococcus coagulasa (-) y streptococcus viridans. En las mujeres que desarrollaron infección cérvicovaginal aumentó significativamente el aislamiento de gardnerella vaginalis, de mycoplasma hominis y de ureaplasma urealyticum y disminuyó significativamente en número de Lactobacillus, en comparación con las pacientes con flora genital normal. No hubo diferencias en la prevalencia de infección cérvicovaginal y vaginosis bacteriana en los grupos estudio y control. El recuento de los leucocitos polimorfonucleares > de 10 por campo al examen al fresco, fue significativamente mayor en el grupo con riesgo que en el control tanto en infección cérvicovaginal 82,1 por ciento (32/39) vs 42,9 por ciento (12/28) p< 0,05, como en vaginosis bacteriana 66,7 por ciento (12/18) vs 15,8 por ciento (3/19) p< 0,005. Conclusiones: en la embarazada con infección cérvicovaginal aumentan significativamente gardnerella vaginalis, mycoplasma hominis y ureaplasma urealyticum y disminuyen significativamente los lactobacillus. Aunque la prevalencia de infección cérvicovaginal y de vaginosis bacteriana es similar en los grupos con y sin riego de infección, la respuesta frente a la agresión bacteriana es diferente. Ambas condiciones microbiológicas producen aumento de la respuesta leucocitaria en el ecosistema vaginal de la mayoría de las mujeres con riesgo de infección y en reducido número en las embarazadas sin riesgo

Microbiología aislada en la rotura prematura de membranas de pretérmino: relación con morbilidad infecciosa materna neonatal e intervalo rotura de membranas-parto / Isolated microbiology in premature rupture of preterm membranes: relation with maternal and neonatal infectious morbility and membranes rupture labor interval

Nuestro objetivo fue conocer la prevalencia de la flora microbiana aislada en la invasión microbiana de la cavidad amniótica e infección cervicovaginal en la rotura de membranas de pretérmino y su influencia sobre la infección materna-neonatal y la duración de la gestación

Mycoplasma hominis y ureaplasma urealyticum en embarazadas e infértiles: diferencias en patologías tubaria / Mycoplasma hominis and ureaplasma urealyticum in pregnant and infertile women: differences in tube pathology

Estudiamos la frecuencia de gérmenes cérvico-vaginales en 47 pacientes embarazadas (entre 16 a 41 semanas de gestación), en 47 pacientes infértiles y en 4 pacientes ginecológicas. Al comparar la frecuencia de presentación de todos los gérmenes estudiados entre las embarazadas y las mujeres infértiles, la mayor diferencia se encontró para u. urealyticum. En efecto, la frecuencia de u. urealyticum fue de 61 por ciento en forma global, 72 por ciento en las embarazadas y 47 por ciento en las infértiles, a diferencia de lo que ocurrió con m. hominis que se presentó con una frecuencia de 18 por ciento para el total de las pacientes estudiadas, 13 por ciento en las embarazadas y 21 por ciento en las infértiles. La mayor frecuencia con que se presentó u. urealyticum en las embarazadas fue estadísticamente significativa y probablemente se deba a un efecto de los estrógenos que facilitan la proliferación de esta bacteria. Dentro del grupo de pacientes infértiles, las que tuvieron daño tubario, presentaron una frecuencia de gérmenes mayor que las sin daño tubario, a diferencia de las con daño tubario en que se presentó con una frecuencia de 25 por ciento

Hemangioma cavernoso en cavidad oral: investigación clínica / Cavernous hemangioma in oral cavity: a clinical investigation

Se estudia el manejo del paciente con hemangioma cavernoso y sobre la utilidad de las substancias esclerosantes previas a la intervención quirúrgica, además de los peligros que existen en el tratamiento inadecuado de la lesión