Guillermo Acuña

Impact of the Novel Influenza A (H1N1) during the 2009 Autumn-Winter Season in a Large Hospital Setting in Santiago, Chile

BACKGROUND In Chile, the novel influenza A (H1N1) epidemic began in the middle-high income area of Santiago. Clinical and laboratory surveillance was intensified with the aim to characterize the epidemic and determine its impact in a large hospital setting. METHODS Demographic and clinical data were obtained from all patients whose symptoms met the clinical definition of influenza A (H1N1) infection during the epidemic period. Laboratory confirmation was obtained by use of a nasopharyngeal antigen detection test for influenza A and/or influenza A (H1N1) polymerase chain reaction (PCR). A case was considered confirmed if the antigen detection test result for influenza A and/or the PCR test result were positive. RESULTS The total number of emergency department (ED) visits increased by 88.5% from a mean of 14,489 ED visits in 2006-2008 to a mean of 27,308 ED visits in 2009, during the epidemic period. There were 10,048 patients who were clinically diagnosed with influenza A (H1N1), and they represented 78% of all visits, of which 4591 (45.6%) were laboratory confirmed. The median time from symptom onset to diagnosis was 1 day, and 99.7% of individuals received antiviral treatment. School-aged children represented 67% of ED visits at the beginning of the epidemic and 24% of ED visits at the end of the epidemic. Only 2% of cases were hospitalized; of these, 70% of cases occurred in patients 6-50 years of age, and 32% of cases occurred in patients who had an underlying medical condition. Eleven patients (age range, 1-53 years) required admission to the intensive care unit (ICU); 6 of these patients had pneumonia with or without hemodynamic shock. No influenza-associated deaths occurred. CONCLUSIONS Many cases of influenza A (H1N1) occurred in school-aged and adult individuals who required an ED visit; these visits resulted in a low impact on the use of hospital beds. Aggressive ICU management and/or experience in extracorporeal membrane oxygenation significantly improved outcomes. Early antiviral treatment may have played an important role in the low number of severe cases. Vaccines targeted for school-aged children and young adults may modify the first epidemic wave in the northern hemisphere.

Regional journals in medicine and public health: A look to the future upon the indexing of the Revista Chilena de Infectología

Revista Chilena de Infectología has recently been accepted for index listing in the Index Medicus via the MEDLINE data base. This breakthrough prompts reflection on the nature of regionally focused subspecialty journals and what such a listing means for better dissemination of scientific and medical discoveries reported in such journals. There is a conscientious global effort at present to better represent regional journals in indexing systems and to make access easier for persons in less wealthy nations to medical and public health information via the internet. These trends are reviewed and discussed in the context of Chiles national medical and public health literature.

Experiencia del trasplante de microbiota fecal a través de colonoscopía en el tratamiento de la infección por Clostridium difficile recurrente

Background: Most cases of Clostridium difficile infection (CDI) respond to a standard course of antibiotics, however recurrent CDI is becoming common and alternative therapeutic strategies are needed. In this scenario, fecal microbiota transplantation (FMT) has been suggested. Aim: To describe the efficacy and safety of FMT for the treatment of recurrent CDI. Patients and Methods: Review of medical records of all patients with recurrent CDI treated with FMT between April 2013 and April 2017. Demographic and clinical data were abstracted including details of treatment prior to FMT, rate of FMT treatment success and clinical course during follow-up period. Telephone surveys were conducted to determine patient satisfaction. Results: Eight patients aged 19 to 82 years (six women) underwent FMT. They experienced a median of four previous episodes of CDI (range 3-8). The mean duration of CDI was 18 days (range 3-36) before FMT. All procedures were performed by colonoscopy. Effectiveness with one session of FMT was 100%. During the follow-up period (median 24 months, range 7-55), two patients developed CDI, one of them after using antibiotics. Adverse events were reported in three patients. Two had bloating and one patient with Crohn’s disease and a history of bacteremia had an episode of Escherichia coli bacteremia. All patients would use FMT again if necessary. Conclusions: FMT through colonoscopy appears to be a safe, effective and long-lasting therapy in cases of recurrent CDI. (Rev Med Chile 2018; 146: 823-830)

Trasplante de microbiota fecal en infección recurrente por Clostridium difficile: Experiencia local a partir de un caso clínico

Fecal microbiota transplantation (FMT) has an incomparable efficacy to treat recurrent Clostridium difficile infection, with near 90% of success. We report a 57 years old woman who developed an antibiotic associated diarrhea with a positive polymerase chain reaction test for Clostridium Difficile toxin. She was successfully treated with Vancomycin trice but diarrhea recurred. Therefore a fecal microbiota transplant was performed using solid stools from a relative, diluted in saline and instilled in the distal ileon, with a good clinical response, without recurrence of diarrhea, during a 6-month follow-up.