Ana María Guzmán

Saccharomyces cerevisiae fungemia after Saccharomyces boulardii treatment in immunocompromised patients.

Saccharomyces cerevisiae is widely used as a probiotic compound. Clinical data suggest that this agent is safe and effective. We report two cases of fungemia caused by S. cerevisiae occurring in immunosuppressed patients treated orally with S. boulardii Molecular typing confirmed clonality in isolate strains from patients and the capsule. Physicians caring for immunosuppressed patients must be aware of this potential serious complication of probiotic use.

Risk Factors Associated With Invasive Fungal Disease in Children With Cancer and Febrile Neutropenia: A Prospective Multicenter Evaluation

Background: Empiric antifungal treatment has become standard of care in children with cancer and prolonged fever and febrile neutropenia (FN), with the downside that it leads to significant over treatment. We characterized epidemiologic, clinical, and laboratory features of invasive fungal disease (IFD) in children with cancer and FN with the aim to identify risk factors for IFD that can aid in better selecting children who require antifungal treatment. Methods: In a prospective, multicenter study, children admitted with FN at high-risk for sepsis, in 6 hospitals in Santiago, Chile were monitored from admission until the end of the FN episode. Monitoring included periodic evaluation of clinical findings, absolute neutrophil count, absolute monocyte count (AMC), serum C-reactive protein (CRP), bacterial cultures, imaging studies, and galactomannan antigen. A diagnosis of proven, probable, and possible IFD was made after episode resolution based on European Organization for Research and Treatment of Cancer classification. Results: A total of 646 high-risk FN episodes were admitted during the study period, of which 604 were enrolled. IFD was diagnosed in 35 episodes (5.8%) of which 7 (1.2%) were proven, 10 (1.6%) probable, and 18 (3.0%) possible. Four variables obtained on day 4 were significantly more common in IFD cases, which were presence of fever, absolute neutrophil count ≤500/mm3, AMC ≤100/mm3, and CRP ≥90 mg/L. The combination of fever, AMC ≤100/mm3, and CRP ≥90 at day 4 provided a RR for IFD of 5.4 (99% CI, 3.2–9.2) with a sensitivity of 75%, specificity of 87%, positive and negative predictive values of 13% and 99%, respectively. Conclusions: Fever persisting at day 4 of admission, together with AMC ≤100 and CRP ≥90 significantly increased the risk for IFD in children with cancer.

Epidemic Clostridium difficile Ribotype 027 in Chile

To the Editor: The increased severity of Clostridium difficile infection is primarily attributed to the appearance of an epidemic strain characterized as PCR ribotype 027 (1). The only report that identified epidemic C. difficile ribotype 027 in an American country outside of North America comes from Costa Rica, raising the possibility that strains 027 might also be present in other countries of Latin America (2). Several studies between 2001 and 2009 have been conducted in South American countries to detect the incidence of C. difficile infection in hospitalized patients, but they did not identify which C. difficile strains were causing these infections (3).

The first case of tinea faciei caused by Trichophyton mentagrophytes var. erinacei isolated in Chile

Background  Trichophyton mentagrophytes var. erinacei is a zoophilic dermatophyte transmitted by hedgehogs which human infections manifest as highly inflammatory and pruritic eruptions.

Diagnóstico rápido de dos casos de mucormicosis con tinción de blanco de calcoflúor

El diagnostico precoz de la mucormicosis es de vital importancia para el manejo del paciente, definiendo extension y radicalidad de la cirugia. El diagnostico se basa en la demostracion del hongo en biopsias, por examen directo con KOH, o con tinciones clasicas como hematoxilina-eosina, acido peryodico o tincion de plata. Otra tecnica util y de poca difusion en nuestro pais es el blanco de calcofluor, tincion fluorescente que se une a la quitina y celulosa de la pared fungica. Se describen 2 casos de mucormicosis, en los cuales el diagnostico inicial se realizo a traves de esta tecnica. En forma rapida e intraoperatoria se visualizaron bajo microscopio de fluorescencia hifas anchas no septadas caracteristicas de los hongos pertenecientes a la Orden Mucorales. La observacion de las estructuras fungicas resulto facil y discriminatoria. Posteriormente por cultivo fueron confirmados como Rhizopus spp

ESTUDIO DE SENSIBILIDAD ANTIMICROBIANA DE 183 CEPAS DE STREPTOCOCCUS AGALACTIAE AISLADAS EN REGION VAGINO-PERINEAL DE EMBARAZADAS EN EL TERCER TRIMESTRE

RESUMENStreptococcus agalactiae es el principal agente causal de sepsis neonatal de aparicion precoz con unaincidencia que fluctua entre 1 y 3 por 1000 recien nacidos vivos. Se han entregado pautas dirigidas a reducirlas tasas de sepsis precoz con la administracion de antibioticos intraparto. Se ha propuesto como antibioticode primera eleccion la Penicilina o Ampicilina, y Clindamicina para pacientes alergicos a las primeras, perotambien se ha planteado el uso de Eritromicina o Cefazolina. Se estudia la sensibilidad a estas drogas, en183 cepas de Streptococcus Grupo B, aisladas en 917 embarazadas, al final del tercer trimestre, en regionvaginal y perianal.PALABRAS CLAVES: Streptococcus grupo Beta, antibioticos sensibilidadSUMMARYStreptococcus agalactiae (Grupo B Streptococcus) is the main bacterial agent involved in neonatalsepsis of early onset (1 to 3/1000 live newborns). Has been given standards for reducing the rates ofneonatal sepsis of early onset using antibiotics during labor. Has been proposed as the first choice Penicilinor Ampicilin and Clindamicin for allergic patients. Erythromycin and Cefazolin has been proposed to treatthis patients.This report study sensibilities for this drugs in 183 Group B Streptococcus strains from vaginal andperianal region of 917 pregnant women during the last trimester.KEY WORDS: Group B Streptococcus, antibiotic sensibilities

Características clínicas, diagnósticas y pronosticas de pacientes con neumonía por Pneumocystis jiroveci en individuos infectados por virus de inmunodeficiencia humana e individuos inmunocomprometidos por otra etiología: comparative study of cases in HIV-infected patients and immunocompromised non-HIV-infected patients

Introduccion: Pneumocystis jiroveci puede causar neumonia en pacientes inmunocomprometidos de cualquier etiologia, pero las diferencias clinicas y pronosticas entre inmunocomprometidos por VIH y por otras causas han sido poco exploradas. Objetivo: Comparar las caracteristicas clinicas, de laboratorio y pronostico de neumonia por P. jiroveci en pacientes inmunocomprometidos por infeccion VIH versus no infectados por VIH. Metodos: Analisis retrospectivo de casos confirmados de neumonia por P. jiroveci en adultos con infeccion por VIH y no infectados, entre los anos 2005 y 2007. Resultados: Se incluyeron 28 pacientes infectados por VIH y 45 no infectados, con neumonia por P. jiroveci confirmada. La poblacion no infectada por VIH presentaba mayor edad (65 vs 36,2 anos, p < 0,01), menor duracion de sintomas previos a la consulta (7 [121] vs 14 [2-45] dias, p < 0,01), mayor requerimiento de tecnica invasora (60 vs 21%, p < 0,01) y estudio molecular (93 vs 68%, p < 0,01) para confirmacion diagnostica, mayor requerimiento de camas criticas (58 vs 25%, p < 0,01), y ventilacion mecanica (56 vs 11%, p < 0,01), con mayor mortalidad atribuible (33 vs 0%, p < 0,01). Conclusiones: La neumonia por P. jiroveci en pacientes inmunocomprometidos no infectados por VIH ofrece mas dificultades diagnosticas y presenta mayor gravedad y mortalidad que en pacientes con infeccion por VIH; por esto, es mandatario optimizar los procesos diagnostico y terapeutico en esta poblacion.BACKGROUND Although P. jiroveci pneumonia affects immunocompromised (IC) patients of any etiology, clinical features and prognostic outcomes are different depending if they are patients with HIV infection or other causes of IC. OBJECTIVES To compare clinical and laboratory features as well as outcomes of P. jiroveci pneumonia in HIV versus non-HIV patients. METHODS Retrospective review of clinical records of HIV and non-HIV patients with P. jiroveci pneumonia managed at the Hospital Clínico Universidad Católica in Santiago, Chile, between 2005 and 2007. RESULTS We included 28 HIV and 45 non-HIV patients with confirmed P. jiroveci pneumonia. The non-HIV population was older (65 vs 36,2 years, p < 0,01), had shorter duration of symptoms (7 [1-21] vs 14 [2-45] days, p < 0,01), required more invasive techniques (60 vs 21%, p < 0,01) and RT-PCR to confirm the diagnosis (93 vs 68%, p < 0,01), were more frequently treated at intensive care units (58 vs. 25%, p < 0,01) requiring artificial ventilation (56 vs 11%, p < 0,01), and had a higher attributable mortality (33% vs 0%, p < 0,01). CONCLUSIONS Our study confirmed that P. jiroveci pneumonia in non-HIV IC patients is more severe, more difficult to diagnose and has higher mortality that in HIV patients. Therefore, it is mandatory to optimize diagnostic and therapeutic strategies for this patients group.

Susceptibilidad a azoles y anfotericina B de aislados de Candida spp: Experiencia de una red de salud universitaria,entre 2004 y 2010

OBJECTIVE To describe antifungal susceptibility testing surveillance (December 2004-September 2010) in Candida spp., for amphotericin B, fluconazole and voriconazole, at the Laboratorio de Microbiología, Pontificia Universidad Católica de Chile. METHOD The study was performed utilizing E test and included yeasts from invasive origin and isolates in which antifungal susceptibility testing was asked for by the patients physician. RESULTS The yeasts were mainly recovered from urine samples (n: 64), blood cultures (n: 51) and secretions (n: 24). Two hundred ninety three isolates were studied: C. albicans (38%), C. glabrata (30%), C. tropicalis (11%), C. parapsilosis (10%), C. krusei (4%) and others (7%). All Candida species were 100% susceptible to amphotericin B, except C. krusei (1/12). Fluconazoles global susceptibility in C. albicans was 91.8%, but 100% in isolates from blood cultures versus 76% in isolates from urine. C. tropicalis was 93.9% susceptible to fluconazole, C. parapsilosis, 90% and C. glabrata 30.3%. C. krusei had no susceptible isolates to fluconazole. Voriconazole resistance was mainly present in C. glabrata (11.5%). CONCLUSIONS We recommend the study of antifungal susceptibility in isolates from invasive origin, selected urine strains and C. glabrata. Fluconazole remains effective in C. albicans from blood.

Determinación de la portación de streptococcus agalactiae: grupo B en embarazadas durante el tercer trimestre mediante inmunoensayo

RESUMENDado que la sepsis neonatal por Streptococcus Grupo B es una enfermedad de alta letalidad, yconsiderando ademas que la portacion de este germen en nuestra poblacion de embarazadas se acercaa 20%, es que, resulta muy importante disponer de algun test rapido y confiable para realizar screening.Este estudio evalua el rendimiento de un inmunoensayo para pesquisa de Streptococcus agalactiae enembarazadas sin factores de riesgo y a fines del tercer trimestre. Los resultados muestran una bajasensibilidad y un bajo valor predictivo positivo para este metodo, lo que no lo hace recomendable para suimplementacion clinica.PALABRAS CLAVES: Sepsis por Streptococcus Grupo B, inmunoensayoSUMMARYNeonatal sepsis of early onset by group B Streptococcus has a high mortality rate. Twenty percent ofour pregnant population have vaginal colonization by this bacterial agent, so clinical practice require a fastand efficient screening test.This report checks a Group B Streptococcus immunoassay screening test in the last trimester forpregnant women without risk factors. The low sensitivity and low positive predictive value of the test makeit not recomendable for clinical practice.KEY WORDS: Group B Streptococcus, immunoassay, perinatal sepsis

[Pneumocystis jiroveci pneumonia: comparative study of cases in HIV-infected patients and immunocompromised non-HIV-infected patients].

Introduccion: Pneumocystis jiroveci puede causar neumonia en pacientes inmunocomprometidos de cualquier etiologia, pero las diferencias clinicas y pronosticas entre inmunocomprometidos por VIH y por otras causas han sido poco exploradas. Objetivo: Comparar las caracteristicas clinicas, de laboratorio y pronostico de neumonia por P. jiroveci en pacientes inmunocomprometidos por infeccion VIH versus no infectados por VIH. Metodos: Analisis retrospectivo de casos confirmados de neumonia por P. jiroveci en adultos con infeccion por VIH y no infectados, entre los anos 2005 y 2007. Resultados: Se incluyeron 28 pacientes infectados por VIH y 45 no infectados, con neumonia por P. jiroveci confirmada. La poblacion no infectada por VIH presentaba mayor edad (65 vs 36,2 anos, p < 0,01), menor duracion de sintomas previos a la consulta (7 [121] vs 14 [2-45] dias, p < 0,01), mayor requerimiento de tecnica invasora (60 vs 21%, p < 0,01) y estudio molecular (93 vs 68%, p < 0,01) para confirmacion diagnostica, mayor requerimiento de camas criticas (58 vs 25%, p < 0,01), y ventilacion mecanica (56 vs 11%, p < 0,01), con mayor mortalidad atribuible (33 vs 0%, p < 0,01). Conclusiones: La neumonia por P. jiroveci en pacientes inmunocomprometidos no infectados por VIH ofrece mas dificultades diagnosticas y presenta mayor gravedad y mortalidad que en pacientes con infeccion por VIH; por esto, es mandatario optimizar los procesos diagnostico y terapeutico en esta poblacion.BACKGROUND Although P. jiroveci pneumonia affects immunocompromised (IC) patients of any etiology, clinical features and prognostic outcomes are different depending if they are patients with HIV infection or other causes of IC. OBJECTIVES To compare clinical and laboratory features as well as outcomes of P. jiroveci pneumonia in HIV versus non-HIV patients. METHODS Retrospective review of clinical records of HIV and non-HIV patients with P. jiroveci pneumonia managed at the Hospital Clínico Universidad Católica in Santiago, Chile, between 2005 and 2007. RESULTS We included 28 HIV and 45 non-HIV patients with confirmed P. jiroveci pneumonia. The non-HIV population was older (65 vs 36,2 years, p < 0,01), had shorter duration of symptoms (7 [1-21] vs 14 [2-45] days, p < 0,01), required more invasive techniques (60 vs 21%, p < 0,01) and RT-PCR to confirm the diagnosis (93 vs 68%, p < 0,01), were more frequently treated at intensive care units (58 vs. 25%, p < 0,01) requiring artificial ventilation (56 vs 11%, p < 0,01), and had a higher attributable mortality (33% vs 0%, p < 0,01). CONCLUSIONS Our study confirmed that P. jiroveci pneumonia in non-HIV IC patients is more severe, more difficult to diagnose and has higher mortality that in HIV patients. Therefore, it is mandatory to optimize diagnostic and therapeutic strategies for this patients group.