Trypanosoma cruzi Parasite Burdens of Several Triatomine Species in Colombia.

Trypanosoma cruzi, the causal agent of Chagas disease, is mainly transmitted by insects of the Triatominae subfamily. In Colombia, there are 26 triatomine species, and 16 of them are naturally infected with the parasite. The parasite loads of naturally infected vectors can be significant in targeting specific species that can affect the epidemiology of the disease. Studying their ecology and behavior is vital to understand their role in T. cruzi transmission dynamics. We evaluated the parasite loads of 182 field-collected triatomines corresponding to 10 species in 13 departments across Colombia. We standardized a methodology to quantify T. cruzi DNA in these insects. We obtained a LOD (limit of detection) of 3.05 p-eq/mL. The 82% of triatomines we evaluated were positive for T. cruzi infection, with loads ranging from hundreds to millions of equivalent parasites per milliliter. Panstrongylus geniculatus, Rhodnius prolixus, and Triatoma dimidiata were the species with the highest loads of T. cruzi; however, other species whose role as vectors is still unknown were also found with high loads of parasites. Our results suggest the relevance of secondary species for T. cruzi transmission in Colombia. We hope our data can help improve entomological surveillance and vector control programs in the country and the region.

Chronic Stress and Ovulatory Dysfunction: Implications in Times of COVID-19.

Stress is known to be associated with adverse health outcomes. The COVID-19 pandemic and its associated lockdowns are examples of chronic stressors. Lockdown measures inadvertently caused significant psychological distress and became a powerful source of anxiety/stress, sleep disturbances, nutritional changes and weight gain. Stress is known to impact women's health specifically, through hypothalamic-pituitary-gonadal (HPG) axis dysfunction and resultant ovulatory dysfunction. Such dysfunction may manifest in menstrual irregularities and/or infertility due to hypothalamic hypogonadism. Here, we review the key physiological mediators of stress and associated ovulatory dysfunction. The kisspeptinergic system is comprised of sets of neurons located in the hypothalamus, the rostral periventricular region of the third ventricle (RP3V) and the arcuate nucleus (ARC). This system links nutrition, reproductive signals and stress. It plays a key role in the function of the HPG axis. During chronic stress, the kisspeptinergic system affects the HPG axis, GnRH pulsatility, and, therefore, ovulation. Leptin, insulin and corticotrophin-releasing hormone (CRH) are thought to be additional key modulators in the behavioral responses to chronic stress and may contribute to stress-related ovulatory dysfunction. This mini-review also summarizes and appraises the available evidence on the negative impact of chronic stress as a result of the COVID-19 pandemic lockdowns. It proposes physiological mechanisms to explain the observed effects on women's reproductive health and well-being. The review suggests areas for future research.

Symptomatic Meckel's Diverticulum in pediatrics. / Divertículo de Meckel sintomático en pediatría.

INTRODUCTION: Meckel's diverticulum (MD) is the remnant of the vitelline duct (VD) also called omphalomesente ric duct and it is considered the most frequent gastrointestinal malformation. Most of the cases are asymptomatic and the diagnosis of this type is always a challenge. OBJECTIVE: To describe 3 sympto matic presentations of MD and to discuss its symptoms, signs, and possible diagnostic-therapeutic tools. CLINICAL CASES: Case 1: A six-month-old patient with obstructive bowel syndrome. In explo ratory laparotomy, an MD was identified with a mesodiverticular band causing an internal hernia. Case 2: A three-year-old patient presenting with digestive hemorrhage and severe anemia requiring blood transfusion. Upper gastrointestinal endoscopy did not show bleeding origin. Due to persis tent melena, the patient required a new blood transfusion. An Abdomen/pelvis tomography scan was performed, showing a suspicious image of MD which was confirmed by laparotomy. Case 3: A newborn with prenatal anencephaly and omphalocele diagnosis. In immediate care of the newborn, meconium evacuation from the umbilical defect was noticed. It was managed as ruptured omphalo cele, installing a bowel silo bag. In primary closure, the permeability of the omphalomesenteric duct was confirmed. An intestinal en bloc resection and anastomosis were performed in all 3 cases. The last one developed an anastomosis leakage resulting in a terminal ileostomy. CONCLUSION: MD, frequently asymptomatic, is often overlooked as a differential diagnosis of abdominal emergencies in children. When suspecting DM with gastric ectopic mucosa, Tc-99m pertechnetate scintigraphy should be performed as a diagnostic procedure of choice, according to each case.

Earthquake segmentation in northern Chile correlates with curved plate geometry.

We performed an integrated analysis of the coseismic slip, afterslip and aftershock activity of the 2014 Mw 8.1 Pisagua earthquake. This earthquake seems to be spatially located between two major historical earthquakes, the 1868 Mw 8.8 earthquake in southern Peru and the 1877 Mw 8.5 earthquake in northern Chile. Continuous GPS data were used to model the coseismic slip of the mainshock and the largest aftershock (Mw 7.6). The afterslip was modeled for 273 days (end of year 2014) after the largest aftershock, revealing two patches of afterslip: a southern patch between the mainshock and the largest aftershock and a patch to the north of the mainshock. Observations from the seismic network indicate that aftershocks were concentrated near the southern patch. Conversely, the northern patch contained hardly any aftershocks, indicating a dominant aseismic slip. The Pisagua earthquake occurred within a prominent, curved section of the Andean subduction zone. This section may have acted as a barrier for the largest historical earthquakes and as an isolated segment during the Pisagua earthquake.

Untangling the transmission dynamics of primary and secondary vectors of Trypanosoma cruzi in Colombia: parasite infection, feeding sources and discrete typing units.

BACKGROUND: Trypanosoma cruzi is the causative agent of Chagas disease. Due to its genetic diversity has been classified into six Discrete Typing Units (DTUs) in association with transmission cycles. In Colombia, natural T. cruzi infection has been detected in 15 triatomine species. There is scarce information regarding the infection rates, DTUs and feeding preferences of secondary vectors. Therefore, the aim of this study was to determine T. cruzi infection rates, parasite DTU, ecotopes, insect stages, geographical location and bug feeding preferences across six different triatomine species. METHODS: A total of 245 insects were collected in seven departments of Colombia. We conducted molecular detection and genotyping of T. cruzi with subsequent identification of food sources. The frequency of infection, DTUs, TcI genotypes and feeding sources were plotted across the six species studied. A logistic regression model risk was estimated with insects positive for T. cruzi according to demographic and eco-epidemiological characteristics. RESULTS: We collected 85 specimens of Panstrongylus geniculatus, 77 Rhodnius prolixus, 37 R. pallescens, 34 Triatoma maculata, 8 R. pictipes and 4 T. dimidiata. The overall T. cruzi infection rate was 61.2% and presented statistical associations with the departments Meta (OR: 2.65; 95% CI: 1.69-4.17) and Guajira (OR: 2.13; 95% CI: 1.16-3.94); peridomestic ecotope (OR: 2.52: 95% CI: 1.62-3.93); the vector species P. geniculatus (OR: 2.40; 95% CI: 1.51-3.82) and T. maculata (OR: 2.09; 95% CI: 1.02-4.29); females (OR: 2.05; 95% CI: 1.39-3.04) and feeding on opossum (OR: 3.15; 95% CI: 1.85-11.69) and human blood (OR: 1.55; 95% CI: 1.07-2.24). Regarding the DTUs, we observed TcI (67.3%), TcII (6.7%), TcIII (8.7%), TcIV (4.0%) and TcV (6.0%). Across the samples typed as TcI, we detected TcIDom (19%) and sylvatic TcI (75%). The frequencies of feeding sources were 59.4% (human blood); 11.2% (hen); 9.6% (bat); 5.6% (opossum); 5.1% (mouse); 4.1% (dog); 3.0% (rodent); 1.0% (armadillo); and 1.0% (cow). CONCLUSIONS: New scenarios of T. cruzi transmission caused by secondary and sylvatic vectors are considered. The findings of sylvatic DTUs from bugs collected in domestic and peridomestic ecotopes confirms the emerging transmission scenarios in Colombia.

[Investigation of vectors and reservoirs in an acute Chagas outbreak due to possible oral transmission in Aguachica, Cesar, Colombia]. / Investigación de vectores y reservorios en brote de Chagas agudo por posible transmisión oral en Aguachica, Cesar, Colombia.

Colombia recorded 11 cases of acute Chagas disease and 80 cases of oral contamination with Trypanosoma cruzi. The current study analyzes the entomological and parasitological characteristics of the outbreak in Aguachica, Cesar Department, in 2010. An interdisciplinary group of health professionals and regional university personnel conducted the laboratory tests in the patients and the investigation of the transmission focus. Eleven cases of acute Chagas diseases were detected in a single family in a dwelling with domiciliated triatomines and Rhodnius pallescens, Pantrongylus geniculatus, Eratyrus cuspidatus, and two Didelphis marsupialis opossums infected with T. cruzi in Attalea butyracea and Elaeis oleifera palm trees in the urban area of Aguachica. The study analyzes the role of R. pallescens and palm trees in the wild cycle of T. cruzi and in oral transmission of Chagas disease. Sporadic incursions by wild R. pallescens, P. geniculatus, and E. cuspidatus from the nearby palm trees into human dwellings may cause increasingly frequent outbreaks of oral Chagas disease.

Investigación de vectores y reservorios en brote de Chagas agudo por posible transmisión oral en Aguachica, Cesar, Colombia / Investigation of vectors and reservoirs in an acute Chagas outbreak due to possible oral transmission in Aguachica, Cesar, Colombia / Investigação dos vetores e reservatórios ao surto da doença de Chagas agudo por possível transmissão oral em Aguachica, Cesar, Colômbia

Colombia tiene un registro de 11 casos de Chagas agudo y 80 casos por contaminación oral con Trypanosoma cruzi. Este trabajo analiza los hallazgos entomológicos y parasitológicos del brote de Aguachica, Cesar, en 2010. Un grupo interdisciplinario de profesionales de la salud y de universidades regionales realizó las pruebas de laboratorio a los pacientes y el estudio del foco de transmisión. Se detectaron 11 casos agudos de enfermedad de Chagas en una sola familia con vivienda sin triatominos domiciliados y, Rhodnius pallescens, Pantrongylus geniculatus, Eratyrus cuspidatus y dos Didelphis marsupialis infectados con T. cruzi en palmas de Attalea butyracea y Elaeis oleifera del área urbana de Aguachica. Se analiza la participación del R. pallescens y el rol de las palmas en el ciclo silvestre de T. cruzi y para la transmisión oral de la enfermedad de Chagas. Incursiones esporádicas de R. pallescens, P. geniculatus y E. cuspidatus silvestres desde palmas cercanas al domicilio humano pueden provocar brotes cada vez más frecuentes de Chagas oral.

Colombia recorded 11 cases of acute Chagas disease and 80 cases of oral contamination with Trypanosoma cruzi. The current study analyzes the entomological and parasitological characteristics of the outbreak in Aguachica, Cesar Department, in 2010. An interdisciplinary group of health professionals and regional university personnel conducted the laboratory tests in the patients and the investigation of the transmission focus. Eleven cases of acute Chagas diseases were detected in a single family in a dwelling with domiciliated triatomines and Rhodnius pallescens, Pantrongylus geniculatus, Eratyrus cuspidatus, and two Didelphis marsupialis opossums infected with T. cruzi in Attalea butyracea and Elaeis oleifera palm trees in the urban area of Aguachica. The study analyzes the role of R. pallescens and palm trees in the wild cycle of T. cruzi and in oral transmission of Chagas disease. Sporadic incursions by wild R. pallescens, P. geniculatus, and E. cuspidatus from the nearby palm trees into human dwellings may cause increasingly frequent outbreaks of oral Chagas disease.

A Colômbia tem registro de 11 surtos da doença de Chagas e 80 casos agudos por contaminação oral com Trypanosoma cruzi. Esta pesquisa analisa os achados entomológicos e parasitológicos do surto de Aguachica, Cesar, em 2010. Um grupo interdisciplinar de profissionais da saúde e de universidades regionais efetuou os testes laboratoriais nos pacientes e o estudo de foco de transmissão. Encontraram 11 casos agudos da doença de Chagas em uma única família com domicilio sem triatomíneos e Rhodnius pallescens, Pantrongylus geniculatus, Eratyrus cuspidatus e dois Didelphis marsupialis infectados com T. cruzi em palmeiras de Attalea butyracea e Elaeis oleifera da área urbana de Aguachica. Analisa-se a participação de R. pallescens e a função das palmeiras em o ciclo silvestre de T. cruzi e para a transmissão oral da doença de Chagas. Incursões esporádicas de R. pallescens, P. geniculatus e E. cuspidatus silvestres das palmeiras próximas ao domicilio humano podem provocar surtos cada vez mais frequentes de Chagas oral.

Infestación por triatominos en comunidades indígenas de Valledupar, Colombia / Infestation by triatomine bugs in indigenous communities of Valledupar, Colombia / Infestação por barbeiros em comunidades indígenas de Valledupar, Colômbia

OBJETIVO: Calcular los índices infestación por triatominos en comunidades indígenas en Colombia. MÉTODOS: Se realizó estudio descriptivo en 19 comunidades indígenas del municipio de Valledupar Departamento de Cesar, Colombia. Durante junio a diciembre de 2007 se recolectaron triatominos por búsqueda activa en las viviendas de los indígenas. Los insectos luego fueron identificados por las claves de Lent & Wygodzinsky. Se desarrolló estudio del proceso infectivo en modelo animal y análisis enzimático de cepas de Trypanosoma cruzi, detectadas en heces de triatominos. RESULTADOS: Rhodnius prolixus presentó índice de densidad en las viviendas de 154,7 por ciento, Triatoma dimidiata de 102,45 por ciento, Triatoma maculata de 109,25 por ciento y Panstrogylus geniculatus de 0,3 por ciento. El índice promedio de infestación de las cuatro especies fue de 40,54 por ciento y, el de infección con T. cruzi de 9,4 por ciento. De cinco hemocultivos positivos para T. cruzi, tres se caracterizaron por isoenzimas, clasificándose en T. cruzi grupo I. El estudio de las biopsias reveló pocas características patológicas durante el proceso de infección con las cepas de T. cruzi aisladas de triatominos domiciliados. CONCLUSIÓN: Los altos índices de infestación por triatominos en las viviendas y el índice de infección por T. cruzi, evidencian la transmisión activa de la enfermedad de Chagas, situación que amerita la aplicación de medidas de control vectorial y el estudio seroepidemilógico de la población en riesgo. La identificación de las cepas de T. cruzi como grupo I concuerda con otros estudios realizados en esta región colombiana.

OBJECTIVE: To calculate triatomine infestation indices in indigenous communities in Colombia. METHODS: A descriptive study was carried out in 19 communities in Valledupar Municipality, Cesar Department, Colombia. During June to December, 2007, triatromine bugs were collected from their resting places in households. Taxonomic identification was made according to the keys by Lent & Wygodzinsky. An infection process in animal model and isozyme analysis of triatomine feces were performed. RESULTS: Rhodnius prolixus showed a density index of 154.7 percent, for Triatoma dimidiata was 102.45 percent, T. maculata 109.25 percent and Panstrogylus geniculatus 0.3 percent. The mean infestation index was 40.54 percent, and mean Trypanosoma infection index was 9.4 percent. Of five hemocultures positive for T. cruzi, three were enzimatically identified as T. cruzi group I. Biopsies revealed few pathologic characteristics of infective process with these strains isolated from domiciliary triatomine bugs. CONCLUSIONS: The high triatomine infestation indices in households and the T. cruzi infection index are evidence of active transmission of Chagas disease. The situation merits a vector control program and serological survey of the population at risk. The genetic characterization of T. cruzi strains as group I agrees with other findings on strains in this region of Colombia.

OBJETIVO: Calcular índices de infestação por barbeiros em comunidades indígenas da Colômbia. MÉTODOS: Estudo descritivo em 19 comunidades do município de Valledupar, departamento de Cesar, Colômbia. A coleta de barbeiros foi realizada por busca ativa nas casas dos indígenas de junho e dezembro de 2007. A identificação taxonômica foi feita conforme Lent & Wygodzinsky. A determinação da infecção foi realizada por processo de infecção em modelo animal e análise enzimática em fezes de barbeiros. RESULTADOS: Rhodnius prolixus apresentou nas casas das comunidades um índice de densidade 154,7 por cento, Triatoma dimidiata de 102,45 por cento e T. maculata de 109,25 por cento e Panstrogylus geniculatus de 0,3 por cento, cujo índice de infestação foi de 40,54 por cento, e índice de infecção com T. cruzi de 9,4 por cento. De cinco hemocultivos positivos para T. cruzi, três caracterizam-se como T. cruzi grupo I. O estudo das biópsias revelou poucas características patológicas da identificação do processo de infecção das cepas isoladas a partir de barbeiros domiciliados. CONCLUSÕES: os altos índices de infestação por barbeiros nas casas e o índice de infecção por T. cruzi evidenciam a transmissão ativa da doença de Chagas, situação que merece a aplicação de medidas de controle vetorial e um estudo seroepidemiológico da população sob risco. A caracterização genética das cepas de T. cruzi como grupo I concorda com outros achados para cepas dessa região da Colômbia.

Infestation by triatomine bugs in indigenous communities of Valledupar, Colombia.

OBJECTIVE: To calculate triatomine infestation indices in indigenous communities in Colombia. METHODS: A descriptive study was carried out in 19 communities in Valledupar Municipality, Cesar Department, Colombia. During June to December, 2007, triatromine bugs were collected from their resting places in households. Taxonomic identification was made according to the keys by Lent & Wygodzinsky. An infection process in animal model and isozyme analysis of triatomine feces were performed. RESULTS: Rhodnius prolixus showed a density index of 154.7%, for Triatoma dimidiata was 102.45%, T. maculata 109.25% and Panstrogylus geniculatus 0.3%. The mean infestation index was 40.54%, and mean Trypanosoma infection index was 9.4%. Of five hemocultures positive for T. cruzi, three were enzimatically identified as T. cruzi group I. Biopsies revealed few pathologic characteristics of infective process with these strains isolated from domiciliary triatomine bugs. CONCLUSIONS: The high triatomine infestation indices in households and the T. cruzi infection index are evidence of active transmission of Chagas disease. The situation merits a vector control program and serological survey of the population at risk. The genetic characterization of T. cruzi strains as group I agrees with other findings on strains in this region of Colombia.

De la seroaglutinacion de Widal a la raeccion en cadena de la polimerasa para el diagnostico de salmonelosis / Widal agglutination of the raeccion Polymerase chain for the diagnosis of salmonellosis

Se hace una revisión de la confirmación del diagnóstico de la fiebre tifoidea por la seroaglutinación de Widal (1896) y por el método moderno y específico de la Reacción en Cadena de la Polimerasa, método inventado por Kary Banks Mullis (1983). Esta revisión se lleva a cabo con ocasión de la validación de este último método en Medellín por Sánchez y Cardona. También, se describen datos biográficos de Widal y Mullis y se comenta el cuadro clínico de la enfermedad.

A review ofthe Widal test (1896) and the polymerase chain reaction (PCR) method invented by Kary BanksMullis (1983) for the diagnosis of typhoid fever is made. This is done due to the validation of this method in Medellín by Sánchez and Cardona.Biographies ofWidal and Mullis, as well as the c1inical manifestations of typhoid fever are also described.

Sensibilidad in-vitro de aislamientos de streptococcus pneumoniae y haemophilus influenzae a varios antibióticos en Medellín, Colombia / In-vitro sensitivity of isolates of streptococcus pneumoniae and haemophilus influenzae to various antibiotics in Medellin, Colombia

Se evaluó la sensibilidad de 72 aislamientos de Streptocoeeuspneumoniae y 47 deHaemopbilus influenzae a varios antibióticos, entre abril de 1997 y junio de 1998, en la Unidad de Bacteriología de la Corporación para Investigaciones Biológicas de la ciudad de Medellín. La sensibilidad de S. pneumoniae fue: vancomicina 100%=trovafloxacina 100%=levofloxacina 100%>ceftriaxona 95.8%>azitromicina 94.4%=claritromicina 94.4% > amoxacilina/clavulonato 91.1% = cefaclor > cefuroxima 88.9% > penicilina 59.3%. La sensibilidad de H. influenzae fue: imipenem 100%=ceftriaxona 100%=ciprofloxacina 100%= trovafloxacina 100%= levofloxacina 100%=cefuroxima 100% =amoxacilina/clavulonato 100%>azitromicina 97.9%>cefepime 95%>ampicilina/ sulbaetam 93.8%>cefaclor 92.9%>grepafloxacina 90%>claritromicina 87.2%. El 14.6% de los aislamientos de H influenzae fueron productores de beta-lactamasas. El aumento de la resistencia a la penicilina por parte del S. pneumoniae es un hecho. Las nuevas quinolonas y los macrólidos son alternativas para el tratamiento. La resistencia del H influenzae no parece ser un problema.

Conjuntivitis por Chlamydia Trachomatis en recien nacidos y lactantes / Conjunctivitis by Chlamydia Trachomatis in new born and infant

Estudiamos 50 ninos con conjuntivitis clinica. En 6 (12%) se detecto Chlamydia Trachomatis, mediante inmunofluorescencia directa con anticuerpos monoclonales, con asociacion de bacterias en dos casos. De los 44 restantes, en 26 se cultivaron bacterias que se observaron en el gram del exudado como S. epidermidis, S. aureus, E. coli, S. pneumoniae, K. pneumoniae y H. influenzae

Antibioticos en pediatria / Antibiotics in pediatrics

Se presenta una revision del tema "Antibioticos en Pediatria". La primera parte esta dedicada a considerar las generalidades sobre aspectos clinicos, bacteriologicos y farmacologicos que orientan en el proceso de seleccionar un antibiotico. La segunda parte se relaciona con los antimicrobianos mas indicados en las infecciones pediatricas mas frecuentes, incluyendo comentarios sobre el diagnostico clinico y dosificacion de las drogas.

Estudio clinico de las amigdalofaringitis agudas / Clinical study of acute tonsillo-pharyngitis

Se analizaron las historias de 160 ninos de 6 meses a 12 anos con amigdalofaringitis aguda a quienes se les practico cultivo de garganta para Estreptococo beta hemolitico del grupo A (EBHGA). A 31.9% se les aislo EBHGA, a 12.5% otros grupos de Estreptococo, en 55.6% el cultivo fue negativo. Los datos clinicos que se asociaron significativamente a amigdalofaringitis por EBHGA fueron: episodios anteriores de amigdalofaringitis, severidad del dolor de garganta, adinamia, malestar, astenia, exudado en amigdalas y garganta, petequias en el paladar y adenopatias submaxilares. Se comentan detalles del diagnostico clinico de las amigdalofaringitis no estreptococcicas. Se hace enfasis en la necesidad de hacer cultivos e investigar en cada localidad la prevalencia de infeccion por EBHGA.

Efectividad del estolato de eritromicina, ampicilina y cefaclor en amigdalofaringitis por estreptococo del grupo a / Effectiviness of eritromicin, ampicillin and cefaclor in streptoccal group A tonsillitis and pharingitis

Se trataron 46 ninos con amigdalofaringitis por Estreptococo Beta Hemolitico del Grupo A; 18 con Estolato de Eritromicina, 13 con Ampicilina y 15 con Cefaclor. No hubo diferencia entre los 3 antibioticos en cuanto a la rapidez de la curacion clinica. Antes del tratamiento las bacterias eran muy sensibles al antibiotico correspondiente a cada grupo, excepto 3 que presentaron sensibilidad intermedia a la Ampicilina. El Cefaclor erradico el Estreptococo en 100% de los pacientes, la Eritromicina en 94,4% y la Ampicilina en 76,9%. Durante el tratamiento con Ampicilina dos cepas de Estreptococo mutaron de muy sensibles a sensibilidad intermedia y a resistencia. Solo se observo intolerancia en dos pacientes que presentaron diarrea con Ampicilina. Los datos anteriores sugieren que la Ampicilina no es droga indicada en el tratamiento de la Amigdalofaringitis Estreptococica

Aislamiento de estreptococo del grupo B en madre e hijo en el parto / Streptococo group B isolation in a mother an Child during delivery

En base al porcentaje cada dia mayor de infecciones neonatales causadas por el Estreptococo B hemolitico del grupo B en varios hospitalarios de Estados Unidos y Europa, se hace un analisis de la colonizacion por esta bacteria en madres y recien nacidos en el momento del parto. En nuestro medio se encuentra un por centaje bajo sin repercusiones patologicas.

Absceso hepatico amibiano agudo agresivo con superinfeccion por bacilo anthrax / Acute agressive amebic hepatic abscess with Anthrax bacilus infection

Se presenta el caso de un paciente de 19 anos con un absceso hepatico amibiano superinfectado con Bacillus anthracis, asociacion no informada en la literatura. El diagnostico se hizo en base al cuadro clinico de fiebre, dolor en hipocondrio derecho, hepatomegalia y tumoracion hepatica. Se confirmo con la ecografia, anticuerpos positivos para amiba histolitica en sangre, y aislamiento del microorganismo en el pus del absceso. El tratamiento se hizo a base de metronidazol, emetina y antibioticos.

Otitis media aguda: clinica, bacteriologia (por timpanocentesis), tratamiento (en 60 inos) / Acute otitis media

Se cultivo la secrecion del oido medio, obtenida por timpanocentesis de 60 ninos con otitis media aguda. Se describe la edad, sexo, cuadro clinico y tratamiento de los pacientes. Se aislaron bacterias por cultivo en el 66,2%: H. Influenzae 29,9% y S. Pneumoniae 24.9% Agregando los hallazgos de la tincion de Gram, S. Pneumoniae fue el germen predominante, 35%. Se determino la sensibilidad de las cepas aisladas a varios antibioticos

Rifampicina isoniazida intermitente en el tratamiento de la tuberculosis pulmonar infantil / Pulmonary infant tuberculosis intermitent in the treatment with rifampin and isoniacid

Se trataron 38 pacientes que tenian tuberculosis pulmonar progresiva, con rifampicina e isoniazida intermitente, despues de una fase inicial diaria; treinta ninos terminaron el tratamiento. Diez tenian neumonia, once bronconeumonia, ocho tuberculosis miliar y uno una caverna. Los resultados fueron muy satisfactorios, pues todos los pacientes curaron clinica y bacteriologicamente. Clinicamente presentaron franca mejoria el 86.2% de los pacientes en el primer mes y el 13,8% a los 4 meses. La curacion bacteriologica fue del 76.4% en el primer mes y del 23.6% entre los dos y los cuatro meses. La mejoria radiologica tuvo lugar en el 73.4% de los casos en los primeros cuatro meses y en el 100% de los casos a los 9 meses. Por estos resultados creemos que el tratamiento quimioterapeutico intermitente con rifampicina e isoniazida es tan efectivo como el regimen de administracion diaria, de facil administracion y acorta el tiempo de tratamiento. Como reacciones toxicas observamos: eosinofilia en el 80% de los casos, la cual persistio generalmente elevada durante todo el tratamiento con algunas fluctuaciones; elevacion de las transaminasas en 18 pacientes en forma transitoria sin necesidad de suspender el...