Bacteremia and endarteritis cases secondary to Campylobacter spp. in a metropolitan hospital. Our experience along a quarter of a centurySix cases of bacteremia and one of endarteritis were identifi ed between 1986 and 2010 in a general hospital in Chile. Five of these cases occurred during the second half of this timeframe, Campylobacter fetus predominated (5 out of 7) and the majority of the infections presented during warmer months. The mean age was 32.4 years (range 19 to 63) all had comorbidities, and main clinical manifestations included fever with diarrhea. Four patients developed hypotension and two septic shock. The latter, associated to C. fetus bacteremia, died before microbiological diagnosis. Six out of 7 patients received antimicrobial therapy. During 2004 and 2010, the rates of Campylobacter spp. positive stool cultures in the same hospital increased 4 times, suggesting an emerging profi le. Bacteremia and endarteritis by Campylobacter spp. can develop in vulnerable patients and manifest as fever with or without diarrhea. Finding curved or spiral shaped gram negative rods in blood cultures leads to suspect this pathogen. Species identifi cation is of utmost importance due to antimicrobial resistance especially in C. jejuni. Prognosis is unfavorable due to host characteristics, and case-fatality rate is high.
Neurocysticercosis (NCC) is not a notifi able disease in Chile and has received little attention on the national medical literature. In order to evaluate the relevance and clinical features of the disease, we performed a retrospective analysis in a general hospital of fi ve cases of NCC during a 11 years period. Age ranged from 3 to 63 years and all had history of living or visiting southern Chile. Three patients had a solitary parenchymal cyst in vesicular or granulomatous stages and presented with generalized seizures. Their outcome was favorable after anticonvulsant and albendazole therapy and cysts reduced in size and calcifi ed during follow-up. The other 2 patients had extraparenchymal or mixed forms, including a pregnant woman with intraventricular cysts who developed endocraneal hypertension and recurrent dysfunction of her ventriculoperitoneal shunt. This patient died after discharge despite an initial favorable evolution with steroids and high-dose albendazole. This case series showed that NCC is still an epidemiological and clinical problem in Chile, affects patients within a wide range of age including children, requires multidisciplinary therapeutic interventions, and has two clinical presentations with different prognosis including one malignant form. To control this infection, a surveillance or reporting system should be initiated.Key words: Neurocysticercosis, diagnosis, complications, drug therapy, albendazole, neglected disease. Palabras clave: Neurocisticercosis, diagnóstico, complicaciones, terapia, albendazol, enfermedad desatendida. Hospital Militarde Santiago, Chile. Departamento de MedicinaServicio de Infectología (AFC, ASS, TW). Servicio de Imagenología (MCS).Servicio de Neurología (CFM, COB). Conflicto de interés: ningunoFinanciamiento: ninguno Recibido: 31 de mayo de 2011Aceptado: 11 de octubre de 2011Correspondencia a:Introducción L a neurocisticercosis (NCC) es la infección parasitaria más frecuente del sistema nervioso central (SNC), la más importante de las causas prevenibles de epilepsia en el mundo en desarrollo y un integrante de la lista de las enfermedades desatendidas (neglected diseases)1 . La OMS estima que la NCC afecta a cerca de 50 millones de personas en el mundo y causa unas 50.000 muertes anuales 1,2 . El conocimiento que se tiene de la NCC en Chile es fragmentario debido a que no es una enfermedad de notifi cación obligatoria y no existe un programa de intervención específi co para su control. Además, su baja frecuencia genera una falsa sensación de seguridad epidemiológica y difi culta el conocimiento clínico que de ella se tiene. No obstante su carácter esporádico, los cuadros de NCC son relevantes debido a su morbilidad prolongada o compleja y porque afectan a una población económicamente activa. Las últimas publicaciones regulares con series de pacientes en Chile según una búsqueda efectuada por PubMed o LILACS para años más recientes, datan de la década del 60, cuando el conocimiento de esta enfermedad estaba basado casi exclusivamente desde una aproximación neu...
Since the appearance of Vancomicin-resistant enterococci (VRE) in our country, the Chilean Ministry of Health recommended the surveillance of intestinal colonization in patients in critical wards. We report the results of surveillance in ICU and onco-hematological wards from 2002 to 2008, with analysis of possible risk factors: demographical data, use and type of antibiotic, days of hospitalization prior to sampling, and year of hospitalization. Colonization rate increased from 0.03 cases per 1000 bed-days in 2003 to 0.18 cases during 2008. Univariate analysis identified 7 risk factors associated with ERV colonization: hospitalization in ICU, use of antibiotics, use of 3 or more compounds, use of imipenem or colistin, > 10 days of hospitalization prior to the study and year of hospitalization (before 2007 or after). Multivariate analysis by logistic binary regression showed that only the last two: >10 days of hospitalization prior to the study and year of hospitalization (before 2007 or after), were significantly associated to colonization by ERV.
Amphotericin B deoxycholate prescription and adverse events in a Chilean university hospitalAmphotericin B deoxycholate is associated with infusion-related toxicity and renal toxicity. Purpose: To evaluate medical indications of this compound in a tertiary care center, analyze adverse reactions, infusion protocols and outcome of treated patients. Patients and methods: Retrospective analysis of 39 treatments indicated in 33 patients during 2007, exploring indications, infusion protocols and renal protective measures, infusion-related adverse reactions, nephrotoxicity, hypokalemia and outcomes. Results: On average, therapy lasted 12 days (2 to 39) and reached 600 mg of accumulated dose (100 to 1950) respectively. 24-hours infusions were applied in 63.2% of prescriptions and 35.9% received a 4-6 hour infusion schedule. In addition, 36.8% received daily a saline infusion before amphotericin. Adverse reactions were observed in 40% of treatments, predominating fever (25%). Nonetheless, nephrotoxicity was infrequent (9.4%), of low magnitude, only affecting patients without previous renal disease, and not requiring dialysis. Hypokalemia developed in 21.6% of treatments. More than half of medical indications were empirical (59%), for presumed infections either by filamentous fungi or yeasts. In the subgroup with microbiological information, main indications were invasive aspergillosis (15.4% of total), systemic candidiasis (12.8%) or meningeal cryptococcosis (10.3%). A favorable response was registered in 41%, and only 48.5% of patients survived. In a multivariate analysis, only age > 60 years remained as an independent factor for developing infusion-related adverse reactions. In the same manner, a SOFA score > 3 and corticosteroids administration at the same time than amphotericin B, were independently associated to a fatal outcome. Conclusion: infusion-related adverse reactions are frequent during amphotericin B deoxycholate therapy, but renal toxicity is occasionally observed. Amphotercin B was used mainly as empirical therapy in this study.
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