Ericson L. Gutierrez

Cutaneous acanthamebiasis infection in immunocompetent and immunocompromised patients

Background  Cutaneous acanthamebiasis is a rare infection and few patients have been reported worldwide.

Convulsive status epilepticus: clinico-epidemiologic characteristics and risk factors in Peru

INTRODUCTION Convulsive status epilepticus constitutes a medical emergency that requires a fast and aggressive management with the objective to prevent neuronal damage and systemic complications. The objective is to determine clinico-epidemiologic characteristics and risk factors associated with convulsive status epilepticus in adults attended in a National Hospital from Lima-Peru in a period of four years. METHODS Case-control study. Cases were constituted by patients admitted for convulsive status epilepticus in the Adult Emergency Service of National Hospital Dos de Mayo between January 2003 and December 2007. Controls were patients with diagnoses of epilepsy that received treatment in outpatient service of neurology, couplet by age and sex with the group of cases. Medical histories were reviewed and patients were interviewed obtaining clinical, epidemiologic and possible risk factors to convulsive status epilepticus that were registered in an instrument of data recorded. RESULTS 41 cases of convulsive status epilepticus were presented. 68.3% were male, 28.6% had age between 20 and 29 years old and 15.5% resided in endemic areas of neurocysticercosis. The more frequent aetiologies were remote symptomatic secondary crisis to cranio encephalic trauma and neurocysticercosis and idiopathic; 26.8% showed some intercurrent infection; while, mortality was of 7.3%. Factors associated with a convulsive status epilepticus were the abrupt interruption or suspension of drugs used for the control of convulsions (p=0.038), chronic intake of alcohol (p=0.030) and irregular antiepileptic treatment (p=0.006). CONCLUSIONS Aetiologies more frequent in the hospital studied from Lima-Peru are remote symptomatic secondary crisis to cranio encephalic trauma, neurocysticercosis and idiopathic. The irregular antiepilepticus treatment constitutes a risk factor to convulsive status epilepticus.

Cutaneous manifestations of internal malignancies in a tertiary health care hospital of a developing country.

In a public hospital in Lima, Peru, 24 patients with 16 types of paraneoplastic dermatoses were identified by data collection. The most frequent dermatosis was dermatomyositis (four patients). The other dermatoses were malignant acanthosis nigricans, palmoplantar keratoderma, bullous dermatoses, lymphomatoid papulosis, edematous scarring vasculitic panniculitis, Norwegian scabies, primary systemic amyloidosis, necrolytic migratory erythema, infective dermatitis, pancreatic panniculitis, generalized pruritus, Lesser-Trelat syndrome, and acquired ichthyosis. Most of these paraneoplastic dermatoses were diagnosed before (45.8%) or at the time of (38.5%) the diagnosis of the underlying malignancy. The most frequent underlying malignancies were lymphoma, adenocarcinomas of the upper digestive tract, and malignant neoplasms of the pancreas. The average age of the patients was 47.0 ± 16.9 years and the length of the disease since diagnosis was 13.7 months. The mortality rate was 75%. Paraneoplastic dermatoses are rare dermatologic entities that are difficult to diagnose. Surveillance is also hampered when patients do not have easy access to health care centers due to financial and geographical issues. However, when identified, they might facilitate the early diagnosis of an associated tumor and contribute to increase the surveillance of patients.

Endemic pemphigus foliaceus in the Peruvian Amazon

Endemic pemphigus foliaceus (EPF) is an organ‐specific blistering disease of the epidermis characterized by the presence of IgG autoantibodies, specifically desmoglein (Dsg)1. This condition has been reported particularly in Brazil, Colombia, Tunisia and Peru.

Molecular characterization and antifungal susceptibility of Cryptococcus neoformans strains collected from a single institution in Lima, Peru

BACKGROUND Cryptococcosis is a fungal infection with a worldwide distribution, mainly caused by Cryptococcus neoformans and Cryptococcus gattii. AIMS To molecularly characterize the mating-types, serotypes, genotypes and antifungal susceptibility profiles of a set of retrospectively isolated C. neoformans strains from Lima, Peru. METHODS A set of 32 Cryptococcus spp. strains from the Institute of Tropical Medicine of the National University of San Marcos, Lima, Peru, were included in this retrospective study. Twenty-four strains were isolated from patients, while the remaining 8 were isolated from the environment. RESULTS Using conventional PCR, 27 (84.4%) of the isolates were identified as C. neoformans var. grubii mating-type alpha and serotype A. Using the AFLP fingerprinting, it was shown that 16 (50%) of the C. neoformans strains were genotype AFLP1, 13 (40.6%) were genotype AFLP1B, 2 (6.3%) were genotype AFLP2, and 1 (3.1%) was found to be a hybrid between both C. neoformans varieties (genotype AFLP3). The antifungal susceptibility profiles for amphotericin B, fluconazole and voriconazole showed that all the 32 C. neoformans are sensitive to these antifungal compounds. CONCLUSIONS In this study we observed that C. neoformans var. grubii (AFLP1 and AFLP1B) and C. neoformans var. neoformans (AFLP2) were the only cryptococcal varieties involved. All strains were found to be sensitive to the antifungals tested, results that are consistent with those found in the international literature.

Automedicación en gestantes que acuden al Instituto Nacional Materno Perinatal, Perú 2011

We aim to determine the prevalence of self prescribing behaviour during pregnancy and its characteristics. For this purpose, we designed a cross sectional study and interviewed 400 pregnant women who had their prenatal care at Instituto Nacional Materno Perinatal, Lima. We found that 10.5% of the patients (42 patients) had a self prescribing behavior during pregnancy, 64.5% think that self prescribing behavior can produce congenital malformations. The medications used were classified as type A and B according to the Food and Drug Administration (FDA). Paracetamol was used more frequently (47.6%) followed by amoxicillin (16.7%). All the women who self-prescribed have had this behavior before pregnancy. According to these results, we conclude there is a low prevalence of self-prescribing behavior during pregnancy compared to the international literature.

Skin diseases in the Peruvian Amazonia

Background  Dermatologic diseases vary widely as a result of geographic location and may be influenced by environmental factors.

Cryptococcus gattii meningoencephalitis in an HIV-negative patient from the Peruvian Andes

We report a case of an immunocompetent Peruvian patient from the Andes with a one-month history of meningoencephalitis. Cryptococcus gattii was identified from a cerebrospinal fluid culture through assimilation of D-proline and D-tryptophan as the single nitrogen source. Initially, the patient received intravenous antifungal therapy with amphotericin B. The patient was discharged 29 days after hospitalization and continued with oral fluconazole treatment for ten weeks. During this period, the patient showed clinical improvement with slight right-side residual weakness. Through this case report, we confirm the existence of this microorganism as an infectious agent in Peru.

Gestante con pénfigo foliáceo endémico y producto libre de enfermedad: Caso clínico

Endemic pemphigus foliaceus (EPF) in an autoimmune skin disease present in areas of the Amazonia. We report a 36 year-old woman who presented EPF at 17 weeks of pregnancy. At 29 weeks, she started antimicrobial treatment and steroids. At the moment of delivery, the disease was in remission and cutaneous lesions were not seen in the neonate. Indirect immunofluorescence titers of total IgG in the mother and in the neonate were negative. Sixteen months later, IgG titers in the offspring were 1/20 and remained negative in the mother, who was on low doses of oral corticosteroids.

Facial porokeratosis: A series of six patients

Porokeratosis is a disorder of epidermal keratinization characterized by annular plaques with an atrophic centre and hyperkeratotic edges, and includes a heterogeneous group of disorders that are mostly inherited in an autosomal dominant fashion. Facial porokeratosis is rare and is not well documented. We present six cases of facial porokeratosis seen over a period of 15 years in a hospital in Lima, Peru. In most of the cases, porokeratosis was found in younger women without any significant past medical history. Oral isotretinoin showed moderate improvement in two of our patients.