E. García Vázquez

Infecciones por Salmonella y Yersinia

Resumen La mayoria de las toxiinfecciones alimentarias se deben a la ingesta de bacterias o virus que contaminan los alimentos o las bebidas, incluidas las aguas, en relacion con una manipulacion, preparacion o conservacion inadecuada de los mismos. La gastroenteritis por Salmonella sigue siendo un problema relativamente frecuente con brotes estacionales en nuestro medio. La mayoria de las personas que presentan infeccion por Salmonella tienen un cuadro de fiebre, diarrea y retortijones que se autolimita, pero los ancianos, los ninos y las personas inmunocomprometidas pueden desarrollar complicaciones graves. En contraposicion, en nuestro medio los casos de fiebre tifoidea, excepto en muy contadas ocasiones, son importados. En cuanto a las infecciones por Yersinia spp., no se documentan casos de peste en nuestro medio y Yersinia enterocolitica es una causa relativamente frecuente de diarrea enteroinvasiva.

Protocolo terapéutico empírico de la neumonía nosocomial

Nosocomial pneumonia is one of the most common infections in hospitalized patients and is associated with high morbidity and mortality. The treatment for these patients is established empirically and should be administered as soon as possible to improve their clinical prognosis. In most cases, microbiological documentation of the pneumonias etiology is not achieved. There is therefore a well-established need for clear action protocols directed to all medical professionals who are in charge of caring for these patients. Resumen La neumonía nosocomial representa una de las complicaciones infecciosas más frecuentes en los pacientes ingresados en los hospitales, asociando una elevada morbilidad y mortalidad. El tratamiento de estos enfermos se establece de forma empírica, debe ser lo más precoz posible para mejorar su pronóstico clínico y además en la mayoría de los casos no se obtiene una documentación microbiológica sobre la etiología de los mismos, por lo que queda bien establecida la necesidad de contar con protocolos de actuación claros y dirigidos a todos los profesionales médicos que se encargan de la atención de estos pacientes. Abstract Nosocomial pneumonia is one of the most common infections in hospitalized patients and is associated with high morbidity and mortality. The treatment for these patients is established empirically and should be administered as soon as possible to improve their clinical prognosis. In most cases, microbiological documentation of the pneumonias etiology is not achieved. There is therefore a well-established need for clear action protocols directed to all medical professionals who are in charge of caring for these patients.

Infecciones por meningococo

Meningococcus (Neisseria meningitidis) is a gram-negative bacterium that causes severe diseases both in children and adults, although it is more prevalent in children younger than 5 years and youths. Meningitis and severe sepsis in meningococcal disease are the primary clinical forms and represent true medical emergencies. The disease is transmitted from person to person by coughing and sneezing. Early diagnosis and treatment have implications for the patient and epidemiological implications, given the availability of chemoprophylaxis and vaccination.

Protocolo diagnóstico del síndrome febril importado

In this protocol we shall set out the steps to follow in the clinical assessment of the patient with fever and where there is an epidemiological history of travel to tropical or subtropical areas. This is not intended to be exhaustive, but as a guide to doctors in their initial diagnostic approach to the patient who has come from the tropics consulting with a fever in the Emergency Department or the hospital ward. Differential diagnosis should be approached first and foremost on the basis of excluding malaria, but haemorrhagic fevers, rickettsiosis, typhoid fever and many other infections, some that are unique to tropical areas, and others that are cosmopolitan but more prevalent in such areas should also be taken into account.

Protocolo terapéutico empírico de la meningitis infecciosa aguda

The prognosis of patients with acute infectious meningitis depends largely on the initiation of appropriate antibiotic therapy, which in most cases is an empirical treatment, prescribed without microbiological information. Hence protocols of management are needed to optimized antibiotic treatments.

Protocolo diagnóstico y terapéutico de la diarrea inflamatoria aguda

The acute inflammatory diarrhea is one of the most common infectious diseases in our environment. The etiology is diverse and it is necessary to consider the specific epidemiological factors of each patient and the underlying conditions and severity on presentation to decide the diagnostic and therapeutic approach.

Protocolo terapéutico de las heridas quirúrgicas infectadas

Surgical site infections, the second type of nosocomial infection in frequency after urinary tract infection, are the most common adverse events affecting hospitalized patients who have undergone surgery. Surgical site infections have been shown to decrease health-related quality of life, increase mortality rates, prolong the length of hospital stay, and increase hospital costs. For these reasons we need guidelines for an early diagnosis and treatment that help us to reduce these adverse effects.

Protocolo diagnóstico del paciente inmunosuprimido sin infección por el VIH y fiebreDiagnostic protocol for immunosuppressed patients without HIV infection and fever

Some patients experience congenital or acquired diseases that severely depress immune mechanisms, which confers a high risk of developing infections, often promoting infections by rare pathogens in other populations and changing the clinical course in a more severe direction. Managing these infections is highly complex and requires a specific diagnostic and therapeutic approach.

Protocolo terapéutico de las infecciones primarias de piel y partes blandas

Skin and soft tissue infections constitute a wide assortment of clinical conditions that affect the skin, subcutaneous cell tissue and muscle, with a spectrum that extends from banal processes to life-threatening conditions. These infections are commonly bacterial, with Staphylococcus aureus, Streptococcus sp. and anaerobic bacteria the most frequently involved microorganisms. Two fundamental categories have been assigned in terms of the anatomical location: superficial and deep. The infections are also classified according to whether they affect the fascia and the muscle compartments and according to severity in simple (cellulitis, erysipelas, impetigo and pyomyositis) and complicated or necrotizing infections (cellulitis and necrotizing fasciitis and myonecrosis). The objective of the following protocol is to describe each of these entities and review the recommendations for their diagnosis and management.

Infecciones por hongos en sujetos no inmunocomprometidos

Resumen Los hongos son un grupo de microorganismos complejos con un ciclo vital que en general incluye formas sexuales y asexuadas. Se pueden clasificar como levaduras y mohos u hongos filamentosos, aunque muchos de ellos se pueden comportar como ambos en diferentes condiciones. En sujetos inmunocompetentes, las infecciones fungicas se limitan en su mayoria a la piel y las mucosas. Sin embargo, se detectan cada vez mas infecciones profundas en sujetos inmunocompetentes relacionadas con los cuidados sanitarios que aparecen por la rotura de los mecanismos de defensa de la piel y las mucosas, especialmente las producidas por Candida . Ademas, algunos hongos como Cryptococcus , Histoplasma , Coccidioides , y Blastomyces pueden producir infecciones profundas tras la inhalacion del microorganismo. El tratamiento de las infecciones fungicas profundas plantea grandes dificultades por la escasez de farmacos activos en este ambito. Ello probablemente condiciona, junto con las condiciones basales de los pacientes en las que ocurren estas infecciones, que la mortalidad de estas sea elevada.