Elba Wu H

Casos fatales de infección por adenovirus

Sixteen fatal cases of adenovirus infection in infants (n:10 aged 1 to less than 12 months) and children (n:6 aged 1 to 3, 8/12 years) are reported. Diagnosis were confirmed by direct viral isolation, viral immunofluorescence or both in 15 patients, and by autopsy in 12 of them, including one without positive virological workup. Evidence of multisystemic compromise, particularly that of severe lower respiratory tract infection was observed and lead to death by acute respiratory failure in all cases. White blood cell counts and erythrocyte sedimentation rate did not help to label initially the etiology as either viral or bacterial. Chest roentgenograms showed pulmonary over-inflation and evidence of pneumonitis as well as extensive and rapidly progressive lung opacifications. Most prominent pathologic findings were necrotizing bronchitis, bronchiolitis and broncopneumonia. Several cells containing typical intranuclear inclusion bodies were documented in ten cases and pneumonitis was the only finding in two. Hepatic fat infiltration and lymphocitic depletion of thymus, spleen and lymphatic nodes occurred in all cases. The need of rapid diagnostic tools to avoid nosocomial spread of this kind of infections with such serious consequences is stressed.

Endocarditis verrucosa secundaria a Saccharomyces cerevisiae: Caso clínico

We report a preterm infant with 30 weeks of gestation, that received broad spectrum antimicrobials during the first days of life. At nine days of life, the infant appeared with abdominal distension and hematochezia. A systolic murmur with changing auscultatory features also appeared. An echocardiography showed an atrial vegetation. A yeast, that was identified as the emergent pathogen Saccharomyces cerevisiae appeared in two blood cultures. Treatment with amphotericin B was started, the dose was adjusted calculating the minimal inhibitory concentration of amphotericin B, and measuring plasma levels of the antimicrobial. Therefore the minimal effective dose was prescribed, avoiding its deleterious effects. After 14 days of antifungal therapy, a new echocardiography showed a reduction in the size of the atrial vegetation. At 35 days, it disappeared and amphotericin B was discontinued. On the outpatient follow up, the infant has shown a normal growth and a normal cardiac auscultation (Rev Med Chile 2002; 130: 1165-9)

Participación viral en las infecciones respiratorias agudas bajas del lactante

; Dra. Teresa Morales M.Viral participation in lower respiratory tract infectionsThis study viral on participation in low acute respiratory tract infections (ARI) in 344 infants under 2 year ofage was carried between years 1983 through 1985, by means of antigen detection and serological tests. A globalpositive isolation, was confirmed in 59.6% of cases (n = 205) with respiratory syncytial virus (RSV: n = 134;65.4%), adenovirus (Ad: n = 41; 20.0%) and parainfluenza viruses (PI: n = 25; 12.7%) as the most commonlyfound agents. Mixed viral infections were detected in 16.6% of cases (n = 34). RSV showed the highest prevalencein all groups, mainly in patients under six months of age. PI increased with patients age and similar but less notice-able raise ocurred in Ad infections. RSV was the only pathogen detected in infants with bronchial obstructivedisease and was the prevalent organism in patients with all the other forms of disease. Ad and PI were equally foundin all clinical syndrome without striking differences among each other. Influenza and citomegalovirus were alsodetected, but not clear evidence of pathogenic role was obtained for the later. Immunofluorescence was the besttechnique for RSV identification while isolation was better for Ad, The relevance of these viruses as causative agentsof low ARI is confirmed and the need to further investigate other non viral etiologic agents is stressed.(Key words: respiratory tract infections, viral, acute, lower, respiratory syncytial virus, parainfluenza virus, adeno-virus).Las infecciones respiratorias agudas son causa epidemiologicos en nuestro pais; en el lactanteextraordinariamente frecuente de morbilidad y entre 28 dias y 11 meses de edad constituyenmortalidad en el lactante en todo el mundo

Forma atípica de enfermedad por arañazo de gato: Compromiso óseo en dos pacientes pediátricos detectado mediante cintigrafía ósea. Revisión de la literatura

Resumen La enfermedad por aranazo de gato (EAG) esuna patologia benigna y autolimitada transmitidapor el rasguno o mordedura de un gato portadorde Bartonella henselae , que se manifiesta comolinfoadenopatia cercana al sitio de inoculacion yque afecta, en 80% de los casos, a sujetos bajo21 anos de edad. Menos de 25% de los pacientesdesarrollara la forma atipica de la enfermedad,con compromiso de organos como higado, bazo,sistema nervioso central y retina. La osteomielitisha sido descrita en series antiguas como de esca-sa ocurrencia, aunque publicaciones recientessugieren una incidencia mayor. El esqueleto axiales el mas frecuentemente comprometido, princi-palmente pelvis y columna dorsolumbar, pudien-do ser las lesiones esqueleticas unicas o multi-ples; estas no siempre son dolorosas y puedenaparecer hasta semanas o meses despues delinicio de los sintomas. Se presenta los casosclinicos de dos ninas con compromiso esqueleti-co, serologia positiva para B. henselae y recupe-racion completa posterior. Una de ellas (edad 12anos) presento fiebre y dolor abdominal severo,demostrandose lesion hipodensa hepatica yosteomielitis multifocal en la columna y pelvis.La otra (edad 10 anos) solo curso con adenopatiasubmandibular, sin fiebre ni compromiso gene-ral, y una lesion indolora en la cresta iliaca,visible al cintigrama oseo (CO). Un CO conlesiones axiales uni o multifocales en un pacientefebril sin etiologia clara, debe hacer sospecharEAG atipica entre las posibles causas. El CO esindispensable si se quiere descartar un compro-miso oseo asociada a EAG, especialmente enpacientes sintomaticos con radiografias norma-les e incluso, aquellos sin dolor oseo.

Infecciones respiratorias agudas intrahospitalarias

To study the incidence of nosocomial respiratory tract infection along the first week after admission, 31 children under 2 years of age admitted to the pediatric wards of a general hospital at Metropolitan Santiago, Chile, with the diagnosis of lower respiratory tract infection, were studied for viral agents by immunofluorescence tests, viral isolation from pharyngeal aspirates, paired serum viral antibodies and bacterial cultures, all of them performed at admission and 4 to 5 days later from May through August 1988. In 13 out of 31 patients admitted because of acute lower respiratory tract infection at least one new virus (to a total of 18 viral isolates) was detected in the second sample, which could have been nosocomially acquired, as follows: adenovirus from 8 cases, respiratory syncytial virus from 5 patients and cytomegalovirus from 5 patients, in different combinations. No significant changes in bacterial cultures were found.

Síndrome respiratorio agudo severo

El objetivo de este articulo es revisar la historia y resaltar la epidemiologia, etiologia, presentacion clinica y manejo del Sindrome Respiratorio Agudo Severo (SARS). El SARS es una enfermedad infecciosa aguda transmisible producida por un agente totalmente nuevo para el ser humano, un coronavirus (SARS-CoV). Iniciada en China, se ha diseminado en pocas semanas a varios otros paises del mundo con miles de casos y cientos de muertes, con una letalidad global de casi el 10%. Por ello, la OMS ha declarado a esta enfermedad como de notificacion inmediata a dicho organismo y ha instaurado una serie de medidas para contener/evitar su diseminacion global y a nivel hospitalario y extra-hospitalario. El diagnostico de esta enfermedad inicialmente es epidemiologico y clinico: aparicion dentro de 10 dias del antecedente epidemiologico (contacto estrecho con una persona sospechosa o con probable SARS; viaje a un area con transmision reciente o actual de SARS) de un cuadro con una fase febril inicial, semejante a un cuadro gripal, y una fase respiratoria posterior, que puede llevar a insuficiencia respiratoria severa; en esta fase destaca lo pobre del examen fisico pulmonar en contraste con la gran cantidad de imagenes radiologicas; otros hallazgos son leucopenia con linfopenia y disminucion de plaquetas; aumento de dehidrogenasa lactica, creatinfosfoquinasa y alanino-aminotransferasa, y algunas alteraciones de la coagulacion. El diagnostico de infeccion por SARS-CoV puede ser confirmado con RT-PCR y deteccion de anticuerpos. El manejo, empirico, ha contemplado antivirales (oseltamivir, ribavirina) y corticoides, con respuestas variables. Comentarios: el SARS ha sido una enfermedad severa, pero que ha dejado muchas ensenanzas , y tambien perdidas, a nivel mundial.

Patología digestiva en niños infectados con el virus de inmunodeficiencia humana (VIH), en Santiago de Chile

Background: Human immunodeficiency virus (HIV) epidemiology has changed, affecting an increasing number of children. As in adults, the disease predominantly affects the digestive and respiratory systems. Aim: To report the gastrointestinal problems in HIV infected pediatric patients. Patients and methods: Twenty four HIV infected children (nine male, aged 1 to 12 years old, followed for 1 to 170 months), are reported. This group has been under care by a multiprofessional team. Results: Oral candidiasis was present in 21 (88%), esophagic candidiasis in 3 (13%), oral ulcers in 4 (17%). Diarrhea was observed in 18 children (75%) and in eight, it had a chronic evolution. Cryptosporidium parvum was the most frequent agent found in six cases (1 with acute and 5 with chronic diarrhea). Schlerosing cholangiopathy was observed in one case, with a fatal outcome, in association to microsporidiosis. Upper endoscopy was done in 11 patients, demonstrating microscopic inflammatory changes in esophagic, gastric and duodenal epithelia in all. Conclusions: Digestive problems are common in HIV infected pediatric patients. They must be always sought actively. Endoscopy is a valuable tool for the early diagnosis of these problems (Rev Med Chile 2003; 131: 19-24)

Transmisión vertical de la infección por virus de inmunodeficiencia humana: Impacto de la aplicación del protocolo ACTG 076 en Chile

La epidemia de SIDA continua extendiendose en Chile, con un mayor incremento en los ultimos anos de la infeccion en mujeres, lo que ha determinado un aumento del numero de ninos expuestos al virus de inmunodeficiencia humana (VIH). Entre las estrategias para disminuir la frecuencia de infeccion en ninos destaca el tratamiento con zidovudina del binomio madre-hijo de acuerdo al protocolo ACTG 076 que ha demostrado una importante reduccion de la transmision vertical. Desde enero de 1995 se inicio en nuestro pais el uso de este protocolo incorporandose hasta diciembre de 1998 el 55,6% de las mujeres gestantes infectadas pesquisadas, obtenien-dose en ellas una reduccion de la transmision a 6,9%. Estos resultados revelan la necesidad de implementar la deteccion rutinaria de la infeccion por VIH en toda mujer embarazada, de manera de ofrecer tratamiento oportuno al binomio madre-hijo

Infección congénita por virus Herpes simples

Prenatal herpes simplex virus infection Five cases of probably intrauterine herpesvirus infection are discussed. Four of them had clinical evidence of neonatal herpes, which was diseminated in two patients, localized to skin in one case and w;th SNC compromised in other. Natal or post natal infections we^e not considered to be possible in these infants due to the presence of symptoms in the first 24 hours of life, which made ascending transcervicat or transplacenta l the most probable route for viral transmission. All cases were treatec with a ten days course of intravenous acyclovir during 10 days. There of them had satisfactory evolution and the other two died at 9 days and at 2 months of life.

Infección por virus de inmunodeficiencia humana en la infancia

This paper describes the increasing trends and changing patterns of human immunodeficiency virus (HIV) infection in children occurring since 1982-83 when the first cases were reported worldwide and from 1987-89 when the first cases were detected in Chile. Advances and obstacles dealing with pediatric HIV in Chile are discussed. The most relevant advance is the outstanding reduction in vertical transmission of HIV associated with the implementation of preventive strategies. Risk of vertical transmission has decreased from 35% in absence of preventive strategies to 2% with prevention that include maternal and newborn antiretroviral therapy elective caesarean section and replacement of breast feeding by artificial milk. The main obstacle to further reduce cases has been the delay in implementation of universal screening for pregnant women. This delay has resulted in that currently the great majority of pediatric HIV cases are detected among symptomatic children. We propose a guideline to detect and appropriately derive pregnant women infected with HIV and children exposed or infected with the virus in order to further reduce the number of children with AIDS in Chile.Se describe el aumento y evolucion que ha tenido, globalmente y en Chile, la infeccion por virus de inmunodeficiencia humana (VIH) en ninos, desde los primeros casos detectados en 1982-83 en el mundo y en 1987-89 en Chile; tambien se describen los progresos y obstaculos que ha presentado el combate de esta entidad patologica en Chile. Entre los progresos destaca la disminucion de la transmision vertical del VIH con la aplicacion de medidas para prevenirla, desde 35% en aquellos binomios madre-hijo en que no se adoptaron medidas preventivas, a 2% en aquellos que si las recibieron (terapia antiretroviral, cesarea electiva, alimentacion artificial al neonato y otras); entre los obstaculos, el principal ha sido el retraso en normar el ofrecimiento de el tamizaje para la infeccion por VIH a toda mujer embarazada. Por esta ultima razon, la mayoria de los ninos infectados con VIH aun se siguen detectando en Chile en la vida postnatal, sobre la base de sus manifestaciones clinicas. Como una manera de ayudar a la prevencion de la transmision vertical del VIH y a la deteccion temprana de los ninos infectados, se presenta un flujograma de pesquisa y derivacion de las mujeres embarazadas infectadas y de los ninos expuestos durante la gestacion e infectados con el VTH