Cecilia erret P

Prevalencia y presencia de factores de riesgo de leptospirosis en una población de riesgo de la Región Metropolitana

BACKGROUND Leptospirosis is a zoonotic disease and its incidence is known in Chile since 2002, when it was incorporated as a disease that must be reported to health authorities. A serologic survey for leptospirosis was performed in humans and animals from a farm in a semi urban area in Santiago Chile, after the death of a farmer due to Weil disease in that place. AIM To report the prevalence of antibodies against leptospirosis and to determine exposure to infection risk factors in the humans and domestic animals studied in this survey. MATERIAL AND METHODS Antibodies were detected by IgM immunodot and indirect haemagglutination test in 61 humans (43 male, aged 5 to 70 years) and by microscopic agglutination test (MAT) in 44 animals. A questionnaire was applied to determine their exposure to risk factors for infection with Leptospira. RESULTS Seventy two percent of the studied population were farm workers and 70% had activities that required contact with water from canals, 41% cleaned closed places where rodents were present. Other risk factors detected were lack of sewage and waste disposal, high level of rodent infestation and disposal of faeces into canals used for watering. Two humans (3.3%) and six animals (1 bovine and 5 rodents) had positive antibodies. Among animals, antibodies against Leptospira serovar pomona and icterohaemorragiae were detected. CONCLUSIONS In Chile, leptospirosis exists not only in rural areas but semi urban ones close to Santiago, although the prevalence is low. Education is necessary among semi urban population to avoid infection.

Complicaciones en niños con varicela en cuatro hospitales de Santiago- Chile: Espectro clínico y estimación de costos directos

Background: The knowledge of varicella complications and their associated cost may help for a better evaluation of varicella immunization benefits. Aim: To determine frequency, type, outcome and affected population of varicella complications in children requiring hospitalization, and to estimate their direct costs. Material and methods: Retrospective analysis of medical records of children admitted to four hospitals in Santiago, Chile, due to varicella complications between January 1997 and February 1999. Calculation of direct costs of hospitalizations in a sample of 30 patients. Results: One hundred fifty four patients were identified, 74% were younger than 5 years old, only one was immunocompromised. Complications identified were skin and soft tissue infections in 63%, invasive infections in 25,3%, neurological in 7.1% and miscellaneous in 4,5%. Staphylococcus aureus and Group A s-haemolytic Streptococcus (GABS) were predominantly isolated. S. aureus was the main agent identified in superficial infections and GABS in invasive infections (sterile sites). Two patients died due to invasive infections (streptococcal toxic shock and S. aureus septicaemia) and 11 required surgical procedures. The average cost per hospitalization was US

Bocavirus humano en Chile: características clínicas y epidemiológicas en niños con infecciones respiratorias

600 in public hospitals and US

Influenza: reemergencia de una antigua enfermedad y el potencial riesgo de una nueva pandemia

1,800 in the private hospital. Conclusions: Varicella complications requiring hospitalization are due mainly to bacterial infections and they affect immunocompetent toddlers. These complications can be severe and even fatal. (Rev Med, Chile 2001; 129, 397-404)

Recomendaciones para el manejo de mordeduras ocasionadas por animales

BACKGROUND Human bocavirus (HBoV) is a newly discovered parvovirus found in children with acute respiratory tract infections (ARTI). OBJECTIVES To describe the epidemiological and clinical profile of children < 5 years old consulting for ARTI, comparing cases of HBoV monoinfection and coinfection with other known respiratory viruses. Furthermore, we aimed to estimate the prevalence of viral shedding in asymptomatic children and perform phylogenetic analysis. PATIENTS AND METHODS We investigated the presence of HBoV in nasopharyngeal secretions from children consulting for AlRTI and among asymptomatic controls, between 2007 and 2008, by polymerase chain reaction. RESULTS HBoV was detected in 79 (21.8%) of 362 nasopharyngeal swabs obtained from children with ARTI. In 60/79 (76%), coinfection with other respiratory viruses was confirmed. Most common symptoms were cough, fever and rhinorrhea. Children infected only with HBoV showed significantly lower frequencies of respiratory distress, oxygen requirements and hospital admission than those with coinfection. HBoV was detected in 6/16 (37.5%) samples from asymptomatic children. The phylogenetic analysis of viruses from Chilean patients revealed that circulating HBoV was closely related to original strains. CONCLUSIONS HBoV was found either in symptomatic and asymptomatic children. The severity of the disease was greater when HBoV was associated to other respiratory viruses.

Perfil clínico-epidemiológico de las infecciones por virus respiratorios en adultos hospitalizados durante la estación de influenza 2004

Resumen Influenza (FLU) es una enfermedad aguda, alta-mente transmisible, que evoluciona en brotes anua-les. La diversidad de los reservorios naturales y lacapacidad de reordenamiento genetico del virus FLUA, hacen que el potencial de pandemia por unanueva cepa este presente. Las medidas de preven-cion incluyen el uso de vacunas inactivadas, las queestan indicadas en lactantes entre 6 a 24 meses devida, pacientes con enfermedades cardiacas ypulmonares cronicas, pacientes inmunocompro-metidos, adultos sobre 65 anos de edad, personal desalud y mujeres embarazadas. La vacuna atenuadanasal tiene indicacion restringida a los grupos deedad entre 5 y 49 anos. La profilaxis con farmacosantivirales esta indicada en brotes y contactos depacientes con factores de riesgo. El manejo conside-ra el uso de farmacos antivirales en los casos graves.Ante una eventual pandemia se deben reforzar lasmedidas de prevencion y hacer un uso racional deantivirales, tanto en profilaxis como en tratamiento. Bibliografia

Evaluación de métodos diagnósticos para sífilis congénita

Las mordeduras producidas por animales domesticos, silvestres o mascotas exoticas, son un problema que no esta bien dimensionado en nuestro medio; sin embargo, representan un motivo de consulta frecuente. Se revisa la epidemiologia, enfrentamiento inicial y recomendaciones para el manejo de mordeduras ocasionadas por perros y gatos; por la gran importancia que han ido adquiriendo en el ultimo tiempo se revisan las mordeduras producidas por hamsters, ratones, conejos, hurones, perros de la pradera, simios, murcielagos, aves, iguanas y animales de granja

Vacuna anti-pertussis para uso en adolescentes y adultos

El comportamiento epidemiologico del virus influenza (FLU) en la comunidad se refleja en el hospital, es planteable que la actividad comunitaria de otros virus respiratorios tambien se traduzca en un alza de las internaciones por estos agentes. Objetivo: describir la presencia y caracteristicas clinico-epidemiologicas de infecciones por virus respiratorios no-FLU (virus respiratorio sincicial-VRS, parainfluenza y adenovirus-ADV) entre adultos hospitalizados durante la temporada de influenza y establecer una comparacion con virus influenza-A (IA) o -B (IB). Pacientes y Metodo: Adultos internados en Hospital Clinico Universidad Catolica, de mayo a julio de 2004, con infeccion por IA o IB, y VRS, parainfluenza (1-2-3) o ADV demostrada por test rapido o inmunofluorescencia directa. Resultados: Se identificaron 86 casos: 73,5% FLU (48,2%, IA y 25,3% IB) y 26,5% no-FLU. (15,7% parainfluenza-2; 8,4% VRS, 1,2% parainfluenza-3 y 1,2% ADV). El grupo con FLU presento mas frecuentemente mialgias, tos, hospitalizacion por sindrome febril, mayores valores de PCR y porcentaje de baciliformes (p < 0,05). Conclusiones: Durante la temporada de influenza 2004, 26,5% de las infecciones entre adultos hospitalizados fueron causadas por virus no-FLU. La dificultad en diferenciar infecciones por virus FLU de no-FLU, plantea la necesidad de ampliar el estudio de la etiologia viral incluso durante la temporada de FLU

Metapneumovirus humano como causa de hospitalización en niños bajo 3 años de edad, con infección respiratoria aguda, durante el año 2004

EVALUATION OF DIAGNOSTIC METHODS FOR CONGENITAL SYPHILIS Congenital syphilis is a relevant problem in our country. At the present, no routine method is available to verify the diagnostic. This multicenter prospective study recruited serum samples reactive for VDRL of sixty mothers with their respective infant (n = 120). In addition to the routinely used screening assay (RPR, VDRL) the following tests were performed: serological detection of specific antibodies to Treponema pallidum for IgM ( Pathozyme , Captia IgM), for IgG (Captia IgG) and for IgG/IgM ( MHA-TP; Pathozyme competition , ICE Syphilis , Determine ). A good agreement was observed between the immunoassays for IgG alone or IgG/IgM (90%) and for IgM alone or IgG/IgM (87.5%). Every mother who had syphilis in the moment of the study or had had syphilis before, and her newborn child, were positive for IgG. Only 64% of the mothers with adequate treatment during their pregnancy had a positive titer for IgM and all of their newborn were not reactive for IgM. The mothers whose treatment was inadequate had IgM titers positive in 82.3% and their children had IgM positive in 11.8%. No correlation was found between a positive maternal IgM titer and the risk of the infant to present the disease. The newborn IgM titer is a useful parameter for an early diagnosis but a negative result cannot discard this pathology.

Influenza pandémica a un año de la primera ola: ¿Qué podemos decir ahora?

A pesar de la vacunacion para prevenirla, la tos convulsiva es una enfermedad aun presente, afectando principalmente a la poblacion de lactantes pequenos con alta morbi-mortalidad, pero tambien a los adolescentes y adultos que han perdido el efecto de la vacunacion inicial; este segundo grupo se ha transformado en el principal reservorio y fuente de transmision de Bordetella pertussis a lactantes. Las nuevas vacunas anti-pertussis, especialmente formuladas para este grupo etario, tienen un buen perfil de inmunogenicidad y de seguridad y su eficacia alcanza a 92%. La utilizacion universal de esta vacuna podria contribuir al control de la tos convulsiva en los grupos mas susceptibles