Zygomycosis over-infection during voriconazole therapy for aspergillosis in a heart transplant patient, successfully treated with liposomal amphotericin and posaconazole.

Aspergillosis and zygomycosis are life-threatening fungal infections in immunocompromised patients. We report a heart transplant recipient with an early pulmonary invasive aspergillosis successfully treated with association of voriconazole and caspofungin. Zygomycosis sinusitis, which was diagnosed while he still was on voriconazole therapy, was successfully treated with the use of combination antifungal therapy including liposomal amphotericin plus posaconazole and conservative surgical debridement.

[Antifungal therapy in special situations: resistant candidiasis and aspergillosis]. / Tratamiento antifungico en situaciones especiales: candidiasis resistente y aspergilosis.

Fungal infections are an increasingly frequent problem in oncohematological patients with febrile neutropenia and hematopoietic precursors transplant recipients. According to the definitions of the EORTC/MSG Consensus Group, the term invasive fungal infection (IFI) is preferred nowadays to name this group of infections. This aims at highlighting the complex disease resulting from a fungal infection involving higher morbidity, longer hospital stays, increased health care costs and higher mortality risk. Candidiasis and aspergillosis account for about 80% of IFIs in oncohematological patients, while Fusarium diseases, mucormycosis, among others, are emerging infections.

Hemorrhagic cystitis secondary to adenovirus infection in a kidney transplant recipient: case report.

Increasingly potent immunosuppressive agents have reduced the incidence of rejection of transplanted organs while increasing patient susceptibility to opportunistic infections and cancer. Adenoviruses are increasingly recognized as contributors to morbidity and mortality in stem cell and solid-organ transplant recipients. Clinical findings range from asymptomatic viremia to respiratory and gastrointestinal disease, hemorrhagic cystitis, and severe disseminated illness. We describe the first case in Chile of hemorrhagic adenovirus cystitis after renal transplantation in an adult.

Impact of highly active antiretroviral therapy (HAART) on the incidence of bacterial infections in HIV-infected subjects.

The aim of this study was to evaluate the effect of highly active antiretroviral therapy (HAART) on the incidence of bacterial infections in HIV-infected patients. Two time periods were compared: (A) January 1992-December 1995 (before HAART) and (B) January 1997-December 2000 (after HAART). During the study periods, we observed 931 patients with bacterial infections, i.e. 322 with bacteremia, 369 with bacterial pneumonia and 240 with urinary tract infections, out of 4,242 HIV-infected subjects admitted to the Department of Infectious Diseases of a large university hospital. By comparing the overall incidence of bacterial infections during periods A and B, a statistically significant difference, from 32% to 18% (p<0.01), was observed. Analysis of risk factors of community- and hospital-acquired bacterial infections did not significantly differ in the two study periods. This study establishes that a significant reduction in bacterial infection incidence occurred in HIV-infected subjects when HAART became the standard therapy for HIV infection.

Correlation between cidofovir-associated uveitis and failing immunorestoration during HAART.

In order to elucidate the factors related to the development of cidofovir-associated uveitis in AIDS patients receiving highly active antiretroviral therapy, the characteristics of 17 AIDS patients with Cytomegalovirus retinitis ( n=10) or progressive multifocal leukoencephalopathy ( n=7) treated with intravenous cidofovir were evaluated. Six cases of cidofovir-associated uveitis occurred among the patients with retinitis. No cases were detected among the patients with progressive multifocal leukoencephalopathy. Stepwise linear regression analysis revealed a significantly higher HIV-viremia level ( P=0.01) and a significantly lower CD4+ cell count ( P=0.009) among cases at the time of uveitis onset in comparison with patients who did not develop uveitis. Thus, cidofovir-associated uveitis seems to occur more frequently in AIDS patients with retinitis in whom highly active antiretroviral therapy fails to restore immunity.

[Mortality in an intensive care unit: predictive value of APACHE II severity score versus maximum APACHE]. / Mortalidad en unidad de tratamiento intensivo: valor predictivo de puntaje de gravedad APACHE II versus APACHE maximo.

Patients admitted to intensive care units (ICU) experience constant changes in their general condition. Therefore, the determination of Apache score within the first 24 hours of admission may not be a reliable index of severity. The aim of this study was to measure daily Apache scores in ICU patients, and to determine if the maximum score (Maximum Apache) attained during hospitalization had a better prognostic value than that of admission. We measured daily Apache scores to 314 patients admitted to Hospital Clínico UC ICU. Mean admission score was 17.5 +/- 9.3 (range: 1-47) and mean maximum score was 18.6 +/- 9.7 (range: 1-47), p < 0.001. Mortality during ICU stay was 17.2%, and 8.6% during hospitalization after ICU discharge. Only 78.3% of patients attained their maximum apache score during the first 24 hours of admission, whereas 21.7% attained it during the rest of ICU hospitalization. Excluding subjects with less than one day of ICU stay, 33% of patients attained maximum Apache score after 24 hours of ICU admission. Statistical analysis showed that maximum Apache score was a better predictor of mortality than that of admission.