A rare cause of headache and fever in a healthy woman / Una rara causa de cefalea y fiebre en una mujer sana

Abstract Cryptococcocis is a fungal infection that primarily affects immunocompromised hosts; disseminated infection is uncommon in immunocompetent patients. We describe a case of a previously healthy woman without risk factors, who was admitted to the emergency department with headache, fever and altered mental status. As a result, a cryptococcal disseminated infection was diagnosed.

Resumen La criptococosis es una infección por hongos que afecta principalmente a huéspedes inmunodeprimidos; la infección diseminada es infrecuente en pacientes inmunocompetentes. Reportamos el caso de una mujer previamente sana, sin factores de riesgo, ingresada a urgencias por cefalea, fiebre y alteración del estado mental quien posteriormente fue diagnosticada con criptococosis diseminada.

The challenging diagnosis of overlapping oral primary/secondary syphilis with nonreactive serology.

The prevalence of oral syphilis, known as "the great imitator" because of its diagnostic complexity and varied clinical manifestations, is increasing worldwide, particularly in people living with HIV (PLWH), who could present false-negative serological results. Although some studies have described the variable presentation of oral syphilis in the context of HIV infection, the difficulty in distinguishing between the primary and secondary stages, clinically and histopathologically, underscores the need to describe atypical cases. We report the case of a 28-year-old HIV-positive man presenting with a 3-month history of painless white/red ulcerated lesion on the soft palate. Physical examination revealed an ulcerated lesion with local signs of inflammation. Initial biopsy revealed a nonspecific inflammatory process and immunohistochemistry (IHC) using anti-Treponema pallidum antibodies showed negative results. The results of serological tests for syphilis (Venereal Disease Research Laboratory and fluorescent treponemal antibody-absorption test) were negative on repeated occasions. Nonetheless, polymerase chain reaction (PCR) assay and subsequent IHC for T. pallidum showed positive results, confirming the diagnosis of oral syphilis. This case illustrates that the diagnosis of oral syphilis is challenging in the absence of serological evidence, and specific tests such as PCR and IHC are useful complementary diagnostic tools.

CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS OF PATIENTS DIAGNOSED WITH COVID-19 IN A TERTIARY CARE CENTER IN MEXICO CITY: A PROSPECTIVE COHORT STUDY.

BACKGROUND: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. OBJECTIVE: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). METHODS: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. RESULTS: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. CONCLUSIONS: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.

Clinical and epidemiological characteristics of patients diagnosed with covid-19 in a tertiary care center in Mexico City: a prospective cohort study

ABSTRACT Background: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. Objective: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). Methods: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. Results: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. Conclusions: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.

[Patients with solid organ transplantation and skin cancer: determination of risk factors with emphasis in photoexposure and immunosuppressive regimen. Experience in a third level hospital]. / Pacientes con trasplante de órgano sólido y cáncer de piel: determinación de factores de riesgo con énfasis en la fotoexposición y el esquema inmunosupresor. Experiencia de un hospital de tercer nivel.

BACKGROUND: Non-melanoma skin cancer (NMSC) is the most common malignancy in transplant patients. The incidence of basal cell carcinoma (BCC) is 10 times greater than in the general population, while squamous cell carcinoma (SCC) is 100 times greater. The relationship between the BCC and SCC reverses and increases according to the degree of immunosuppression and sun exposure. One way to predict the risk of NMSC should be based on factors such as: total sun burden factor (TSB). OBJECTIVE: To determine the influence of various risk factors in the development of NMSC and its relation to the type and duration of immunosuppressive treatment, type of transplant, and TSB. METHODS: We worked with a fledgling historical cohort in which patients with kidney or liver transplant were identified and recorded if they developed some form of skin cancer. To study the factors associated with NMSC, we resorted to the strategy of a case-control study. Dermatological examination was performed and a questionnaire of risk factors made in both groups. RESULTS: Of the 140 patients enrolled, 51 were women and 89 men, 120 were renal transplant recipients and 20 liver transplants. Of patients who developed NMSC, 100% were renal transplant recipients. The median age was 48.5 years. Most cancer patients worked outdoors. A total of 78 lesions were found in 40 NMSC patients, 59 (76%) of them were SCC, and 19 (24%) BCC; 45% of all skin cancer patients had more than one injury. The worst affected areas were those photoexposed: 60% head and neck, trunk and upper extremities 18% 50%. In 30% of patients (12/40) 22 new tumors were identified (SCC 18 and BCC 4). No lesions were identified for melanoma. In multivariate logistic regression analysis, statistically significant features were: type-based immunosuppressive regimen of cyclosporine A, azathioprine and prednisone (OR: 59.7; 95% CI: 10.2-348), TSB > 10 (OR: 19; 95% CI: 3-120) and duration of use of immunosuppressive therapy (OR: 1.06; 95% CI: 0.9-1.1). The mean time from transplantation to first dermatological assessment was six years (+5.4). Of the patients, 93% had not regularly used sunscreen before and after transplantation. CONCLUSIONS: The dermatological assessment is convenient and easy to perform. Primary prevention, close monitoring, diagnosis, and treatment of skin lesions are essential components of a comprehensive program for the evaluation of transplant recipients, the purpose of which is to reduce the incidence and morbidity associated with cancer.

[Flouroquinolone activity in clinical isolates of Streptococcus pneumoniae with different susceptibility to penicilline: an epidemiological study in five cities of Mexico]. / Actividad de las fluoroquinolonas en aislamientos clínicos de Streptococcus pneumoniae con diferente susceptibilidad a la penicilina: estudio epidemiológico en cinco ciudades de la República Mexicana.

OBJECTIVE: Determine the susceptibility to five fluoroquinolones and cross-resistance of pneumococcusclinical isolates with different penicillin susceptibilities gathered in a community-based study. DESIGN: Cross-sectional survey. MATERIALS: Two hundred and thirty one (231) isolates were obtained from respiratory secretions or blood specimens from 231 patients with acquired acute respiratory infection or bacteremia. OUTCOME MEASURES: In vitro susceptibility to penicillin (PEN), ciprofloxacin (CIP), levofloxacin (LEV), gatifioxacin (GAT), moxifloxacin (MOX) and gemifioxacin (GEM) was determined with minimal inhibitory concentration (MIC) using the E test. RESULTS: 42% of the isolates showed decreased susceptibility to PEN. The lowest antibiotic concentration that inhibited 90% of the isolates was 3 microg/ml (for CIP), 1 microg/ml (for LEV), 0.25 microg/ml (for GAT), 0.125 microg/ml (for MOX) and 0.032 microg/ml (for GEM). Median MIC for LEV, GAT, MOX and GEM increased with decreasing susceptibility to CIP. Susceptibility to CIP was similar between penicillin-susceptible and penicillin-resistant pneumococci. CONCLUSION: Third and fourth generation fluoroquinolones showed very high inhibitory activity, higher than that for CIP, for both penicillin-susceptible and penicillin-resistant pneumococci. We noted cross-resistance among fluoroquinolones.

Actividad de las fluoroquinolonas en aislamientos clínicos de Streptococcus pneumoniae con diferente susceptibilidad a la penicilina: Estudio epidemiológico en cinco ciudades de la República Mexicana / Flouroquinolone activity in clinical isolates of Streptococcus pneumoniae with different susceptibility to penicilline: An epidemiological study in five cities of Mexico

Objetivo: Determinar el grado de sensibilidad a cinco fluoroquinolonas, y la resistencia cruzada, en aislados clínicos de neumococo con diferente susceptibilidad a la penicilina Diseño: Estudio transversal Lugar: Los aislamientos de Streptococcus pneumoniae (Sp) se obtuvieron en cinco centros de atención médica y en un laboratorio de referencia de cinco ciudades de la República Mexicana, durante febrero de 1999 a mayo del 2000. Material: 231 aislamientos de Sp obtenidos de muestras de secreción de la vía aérea o sangre, de 231 pacientes con infección respiratoria aguda o bacteriemia adquiridas en la comunidad. Mediciones: Se midió la susceptibilidad in vitro a penicilina (PEN), ciprofloxacina (CIP), levofloxacina (LEV), gatifloxacina (GAT), moxifloxacina (MOX) y gemifloxacina (GEM) mediante la determinación de la concentración mínima inhibitoria (CMI) con la prueba E. Resultados: 42% de los aislamientos mostraron susceptibilidad disminuida a la PEN. La mínima concentración del antibiótico que logró inhibir al 90% de los aislamientos fue de 3 µg/ml (para la CIP), 1 Hg/ml (para la LEV), 0.25ng/ml (para la GAT), 0.125 µg/ml (para la MOX) y 0.032 µg/ml (para la GEM). La mediana de la CMI para la LEV (GAT, MOX y GEM) se incrementó proporcionalmente a la disminución de la sensibilidad del neumococo a la CIP. La susceptibilidad a la CIP fue semejante entre los aislamientos sensibles y resistentes a la PEN. Conclusión: las fluoroquinolonas de tercera y cuarta generación mostraron tener buena actividad inhibitoria del neumococo, incluyendo a las cepas resistentes a la PEN, siendo mayor que la de CIP. Se documentó resistencia cruzada entre las fluoroquinolonas.

Objective: Determine the susceptibility to five fluoroquinolones and cross resistance of pneumococcus clinical isolates with different penicillin susceptibilities gathered in a community based study . Design: Cross sectional survey. Materials: Two hundred and thirty one (231) isolates were obtained from respiratory secretions or blood specimensfrom 231 patients with acquired acute respiratory infection or bacteremia. Outcome measures: In vitro susceptibility to penicillin (PEN), ciprofloxacin (CIP), levofloxacin (LEV), gatifloxacin (GAT), moxifloxacin (MOX) and gemifloxacin (GEM) was determined with minimal inhibitory concentration (MIC) using the E test. Results: 42% of the isolates showed decreased susceptibility to PEN. The lowest antibiotic concentration that inhibited 90% of the isolates was 3 Hg/ml (for CIP), 1 µg/ml (forLEV), 0.25 µg/ml (for GAT), 0.125 µg/ml (for MOX) and 0.032 µg/ml (for GEM). Median MIC for LEV, GAT, MOX and GEM increased with decreasing susceptibility to CIP. Susceptibility to CIP was similar between penicillin susceptible and penicillin resistant pneumococci. Conclusion: Third and fourth generation fluoroquinolones showed very high inhibitory activity, higher than that for CIP, for both penicillin susceptible and penicillin resistant pneumococci. We noted cross resistance among fluoroquinolones.

High prevalence of Chlamydia pneumoniae seropositivity in Mexican patients with ischemic heart disease.

BACKGROUND: Risk factors for development of atherosclerosis, such as hyperlipidemia, high blood pressure, smoking habit, and diabetes mellitus, have been identified. The possibility that infectious agents may unchain biological and biochemical reactions related to inflammation, atherogenesis, and vascular thromboses events have recently been described. Chlamydia pneumoniae has been associated with coronary artery disease in some seroepidemiology studies. Reports of this association are limited in the Latin American population; therefore, we conducted a case-control study to explore this issue in the Mexican population. METHODS: Eighty nine patients with scintigraphic evidence of coronary artery disease compared with a control group of 105 individuals were analyzed. Serum levels of IgA, IgM, and IgG against Chlamydia pneumoniae were determined using enzyme immunoassay method in all subjects. Conventional risk factors were also analyzed. RESULTS: High seroprevalence of IgA and IgG with no significant difference between the two groups was found. Prevalence of antibodies was as follows: IgA 56.2% (50/89 patients); IgG 66.3% (59/ 89 patients) in coronary artery disease group; IgA 56.2% (59/105 patients), and IgG 70.5% (74/105 patients) in control group. Among common risk factors for coronary artery disease, significant differences were found in males, in patients with diabetes, and in habitual smokers. CONCLUSIONS: These results suggest a high prevalence of C. pneumoniae infection in the studied population. However, in this series seroprevalence was not evidently associated with coronary artery disease (CAD). To clarify the possible relation between C. pneumoniae and coronary atherosclerosis, additional studies must be performed.

Prevalence and risk factors associated with the presence of peripheral neuropathy in patients with hepatitis C virus infection.

OBJECTIVES: To determine the frequency and risk factors associated with peripheral neuropathy in a population of patients with hepatitis C virus infection. METHODS: Cross-sectional study. Electrophysiological assessment included bilateral motor and sensory conduction studies of four limbs. RESULTS: Thirty-one cases and 31 control subjects were studied. Eighteen patients (58%) from the group of patients infected with the hepatitis C virus had evidence of neuropathy. Only 3 (10%) persons from the control group exhibited neuropathy. Among the risk factors for neuropathy in the patients infected with hepatitis C virus, we found the following: positive rheumatoid factor, cryoglobulinemia, and cirrhosis or active hepatitis. Other risk factors were advanced age, prolonged time of evolution, high viral load of the hepatitis C virus, and low complement. CONCLUSIONS: The frequency of neuropathy encountered in our study was high (58%). In our study, a positive rheumatoid factor, cryoglobulins, and a high viral load were also associated with the presence of peripheral neuropathy. A high viral load could express possible direct viral damage.

Pronóstico de la diarrea por rotavirus / Prognosis of rotavirus diarrhea

Objetivo. Comparar la gravedad de la diarrea por rotavirus (RV) y por no rotavirus. Material y métodos. Estudio transversal en 520 lactantes con diarrea aguda, efectuado entre octubre de 1994 y marzo de 1995 en siete centros del primer nivel de atención en cinco estados de México. El diagnóstico de RV se realizó con ensayo inmunoenzimático o por electroforesis. El análisis se hizo a través de medidas de tendencia central. Los resultados se presentan como promedio y desviación estándar o mediana o variación. Resultados. Se aisló RV en 264 lactantes (50.7 por ciento) con predominio en varones de 6 meses a un año. Las manifestaciones clínicas fueron significativamente diferentes entre el grupo rotavirus positivo y el grupo rotavirus negativo en mediana de evacuaciones por 24 horas, frecuencia de vómitos, temperatura > 38º C, deshidratación y calificación de gravedad, respectivamente. Conclusiones. Estos resultados mostraron peor pronóstico por mayor gravedad de la diarrea por RV en lactantes, con relación a otra etiología. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/index.html

Uso de bebidas y alimentos en el hogar durante la diarrea aguda del niño: estudio etnográfico en una zona rural mexicana / Use of solutions and foods at home during episodes of acute childhood diarrhea: an athnographic study conducted in a rural mexican area

Con el objeto de explorar algunas creencias acerca de la enfermedad diarreica en el niño así como el uso de bebidas de elaboración casera y hábitos de alimentación durante la enfermedad se aplicó un cuestionario estructurado a través de una entrevista personal a 142 madres campesinas. La mayoría de las entrevistadas respondió que acostumbraba dar algún tipo de té (90%) o una bebida de arroz (77%) a su niño con diarrea. Sólo el 18%mencionó el uso de sobres de hidratación oral. Sesenta y tres porciento dijo restringir ciertos alimentos en particular y 25%sometió a ayuno total, usualmente por más de 24 horas, al niño con diarrea. En vista del uso extendido y del propósito perseguido por la madre al dar atole de arroz se justifica el evaluar la eficacia clínica de esta bebida en la prevención de la deshidratación, así como el promover una dieta basada en alimentos disponibles localmente y aceptados culturalmente para el manejo domiciliario del niño con diarrea aguda

Memorias del V curso internacional: avances en enfermedad diarreica y desequilibrio hidroeletrolitico / Memories of the V international course: advances in diarrheic disease and hydroelectrolitical unbalance

No obastante que el uso de la terapia de hidratación ha mostrado su eficacia para prevenir la deshidratación, para reponer los líquidos perdidos y para mantener el adecuado balance hídrico mientras la diarrea persiste, la OMS y otras instituciones de salud han favorecido el uso de bebidas o soluciones basadas en preparaciones caseras que han mostrado ser útiles en el tratamiento de las diarreas y han sido aceptadas por las madres, esto a ocurrido particularmente en zonas rurales donde hay una alta ocurrencia de estos casos. Una de estas preparaciones es la "solución de hidratación a base de harina de arroz" con electrolitos, la cual ha sido utilizada con éxito en varios estudios. el presente trabajo es un estudio de niños menores que presentaron deshidratación secundaria provocada por diarrea aguda. Agrupados en grupo control tratados a base de solución hidratante oral y, grupo de estudio tratados con solución hidratante a base de harina de arroz. La respuesta a este ultimo tratamiento fue significativamente favorable. Sin embargo, la recomendación es que la solución a base de harina de arroz solo debe ser empleada en el hogar en las etapas iniciales de la diarrea aguda, sólo en caso de no disponer de la solución hidratante oral; no debe intentarse sustituir a ésta