Luis Thompson

Epidemiology of Candidemia in Latin America: A Laboratory-Based Survey

Background The epidemiology of candidemia varies depending on the geographic region. Little is known about the epidemiology of candidemia in Latin America. Methods We conducted a 24-month laboratory-based survey of candidemia in 20 centers of seven Latin American countries. Incidence rates were calculated and the epidemiology of candidemia was characterized. Results Among 672 episodes of candidemia, 297 (44.2%) occurred in children (23.7% younger than 1 year), 36.2% in adults between 19 and 60 years old and 19.6% in elderly patients. The overall incidence was 1.18 cases per 1,000 admissions, and varied across countries, with the highest incidence in Colombia and the lowest in Chile. Candida albicans (37.6%), C. parapsilosis (26.5%) and C. tropicalis (17.6%) were the leading agents, with great variability in species distribution in the different countries. Most isolates were highly susceptible to fluconazole, voriconazole, amphotericin B and anidulafungin. Fluconazole was the most frequent agent used as primary treatment (65.8%), and the overall 30-day survival was 59.3%. Conclusions This first large epidemiologic study of candidemia in Latin America showed a high incidence of candidemia, high percentage of children, typical species distribution, with C. albicans, C. parapsilosis and C. tropicalis accounting for the majority of episodes, and low resistance rates.

Antifungal Susceptibilities, Varieties, and Electrophoretic Karyotypes of Clinical Isolates of Cryptococcus neoformans from Brazil, Chile, and Venezuela

ABSTRACT One hundred clinical isolates of Cryptococcus neoformans from human immunodeficiency virus (HIV)-infected and non-HIV-infected patients from Brazil, Chile, and Venezuela were separated according to varieties and tested for antifungal susceptibility. A high susceptibility to antifungal agents was observed among all the isolates. The electrophoretic karyotyping of 51 strains revealed good discrimination among Cryptococcus neoformansvar. neoformans strains.

Pandemic influenza A (H1N1) 2009 with neurological manifestations, a case series.

Please cite this paper as: Noriega et al. (2010) Pandemic influenza a (H1N1) 2009 with neurological manifestations, a case series. Influenza and Other Respiratory Viruses 4(3), 117–120.

Staphylococcus aureus comunitario resistente a cloxacilina: Comunicación de los primeros cinco casos descritos en Chile

Community acquired infections with methicillin resistant strainsof Staphylococcus aureus (MRSA) infections have a more aggresive clinical course and involvemostly skin and lungs. These infections appear as outbreaks among prisoners, sportsmen, menhaving sex with men and military personnel. The higher aggressiveness of these strains is due tothe production of several toxins, mainly Panton-Valentine leukocidine. The detection of thegene that codes for this toxin is a distinctive feature of these strains. We report five patients withcommunity acquired MRSA infections. The clinical presentation was a skin infection in all. Onepatient had a pleuropneumonia in addition. Apart for resistance to beta-lactam antimicrobials,the strains were resistant to erythromycin and ciprofloxacin. Patients were treated withvancomycin, clotrimoxazole or intravenous clindamycin with a good evolution. Anepidemiological surveillance for community acquired MRSA strain infections should be startedand measures to adequately treat infected patients and avoid dissemination should beimplemented (Rev Med Chile 2008; 136: 885-91).(

Breakthrough bacteremia due to Clostridium tertium in a patient with neutropenic fever, and identification by MALDI-TOF mass spectrometry

Clostridium tertium is rare in a human clinical specimen and its pathogenicity is often uncertain. However, the organism has been increasingly recognized as a cause of bacteremia and other infections in immunocompromised patients, especially those with hematologic malignancies. The diagnosis and treatment of C. tertium are difficult due to its growth pattern, micromorphology, and antibiotic resistance. The organism can easily be misidentified as Gram-positive aerobic rods such as Bacillus species, usually considered as a contaminant. Furthermore, it is not covered by empirical treatment with many broad-spectrum antibiotics. Here we report a case of breakthrough bacteremia due to C. tertium that occurred in a patient with acute leukemia and neutropenic fever, who was treated with an empirical regimen of ceftazidime and amikacin. The bacterium was rapidly identified by new mass spectrometry technology (MALDI-TOF MS) and the patient recovered under meropenem and vancomycin treatment, without complications.

Respiratory infections and bacteremia caused by Neisseria meningitidis serogroup W

N. meningitidis serogroup W has recently been introduced into Chile. This serogroup has been associated with hypervirulent strains capable of causing outbreaks. Furthermore, there is data suggesting that the spectrum of clinical manifestations varies among different serogroups. Here we describe three cases of community acquired respiratory infections caused by N. meningitidis W, which were diagnosed by blood culture during 2013 in our hospital.

Micobacterias atípicas en cinco pacientes adultos sin evidencias de inmunosupresión: Construyendo una experiencia

El objetivo de este trabajo es reportar la experiencia acumulada sobre infecciones por micobacterias atipicas en pacientes sin inmunosupresion. Entre el ano 2008 y 2013 se observaron cinco pacientes con infeccion por micobacterias atipicas: dos con infeccion cutanea y tres con infeccion pulmonar. Ninguno de estos pacientes tenia evidencias de inmunosupresion. Un paciente con bursitis de codo por M. chelonae tuvo un estudio citoquimico con aumento de celularidad de predominio mononuclear y desarrollo de bacterias al quinto dia; respondio favorablemente a claritromicina. Un caso con infeccion cutanea por M. fortuitum evoluciono en forma prolongada con supuracion ganglionar antes del diagnostico y el cultivo solicitado a los 13 dias fue positivo. Los tres pacientes con aislados pulmonares presentaron tos y expectoracion y tenian en comun ser mujeres en edad post-menopausica y presentar pequenos infiltrados nodulares asociados a bronquiectasias en el estudio de imagenes pulmonares, un patron descrito en la literatura cientifica. En estos tres casos, la latencia entre la toma de muestra y el informe definitivo tuvo un rango de 40 a 89 dias. El aislamiento de micobacterias atipicas en muestras de expectoracion en pacientes sin inmunosupresion se da en un contexto tipico pero plantea dificultades diagnosticas y terapeuticas. El lento crecimiento de estos microorganismos en el laboratorio contribuye a este problema.BACKGROUND Respiratory infection caused by Pneumocystis jiroveci is a common opportunistic infection in patients with human immunodeficiency virus (HIV) with CD4 counts < 200 cells/mm³. However, it has also been reported in patients with other causes of immunosuppression. OBJECTIVES To compare the characteristics, severity and mortality of respiratory infection by P. jiroveci in patients with and without HIV infection. METHODS Retrospective cohort follow-up of adult patients admitted to our hospital with infection by P. jiroveci since 2006 to 2013. RESULTS We included 82 patients with respiratory infection by P. jiroveci of which 55% (45) were not infected with HIV. In this group, 68.8% (31) had diagnosis of cancer and 20% (9) received solid-organ transplant. 57.9% (26) were hospitalized in an intensive care unit. 42.2% (19) suffered multiple organ failure (MOF), 46.7% (21) required mechanical ventilation (MV) and 40.9% (18) inotropic drugs. Mortality was 33.3% (15). Statistically significant differences were observed between groups in age (p <0.001), requirement of MV (p <0.001) inotropic drugs (p 0.001) and MOF (p <0.001). Mortality was higher in the HIV-positive group, reaching statistical significance (p 0.007). CONCLUSION Pneumocystis pneumonia mortality was higher in patients without HIV, who suffered more complications and progression to respiratory failure with MOF.Background: Respiratory infection caused by Pneumocystis jiroveci is a common opportunistic infection in patients with human immunodeficiency virus (HIV) with CD4 counts Introduccion: La infeccion respiratoria por Pneumocystis jiroveci constituye una patologia oportunista frecuente en pacientes infectados con virus de inmunodeficiencia humana (VIH), con recuentos de LTCD4

Imported scrub typhus: first case in South America and review of the literature

BackgroundScrub typhus is a neglected vector-borne zoonosis causing life-threatening illnesses, endemic in the Asian-Pacific region and, as recently discovered, in southern Chile. Scrub typhus is rarely reported in travelers, most probably due to the lack of clinical experience and diagnostic tests in non-endemic countries. We report the first case of imported scrub typhus in South America.Case presentationA 62-year-old tourist from South Korea presented severely ill with fever, rash, and eschar in Santiago, Chile. Laboratory exams showed thrombocytopenia and elevated inflammation parameters, hepatic enzymes, and LDH. With the clinical suspicion of scrub typhus, empirical treatment with doxycycline was initiated and the patient recovered rapidly and without complications. The diagnosis was confirmed by IgM serology and by real-time PCR, which demonstrated infection with Orientia tsutsugamushi (Kawasaki clade).ConclusionsOnly due to the emerging clinical experience with endemic South American scrub typhus and the recent implementation of appropriate diagnostic techniques in Chile, were we able to firstly identify and adequately manage a severe case of imported scrub typhus in South America. Physicians attending febrile travelers need to be aware of this rickettsiosis, since it requires prompt treatment with doxycycline to avoid complications.

Falla de tratamiento en neumonía adquirida en la comunidad: coccidioidomicosis en un viajero

Treatment failure in community-acquired pneumonia is defined as a clinical condition with inadequate response to antimicrobial therapy. Resistant and unusual microorganisms and noninfectious causes are responsible for treatment failure. Coccidioides immitis is a fungus that causes pneumonia in the northern hemisphere, especially in the United States and northern Mexico. We report a case of pulmonary coccidioidomycosis imported from Mexico to Chile. After a comprehensive study, histopathology was able to establish Coccidiodes immitis as the causative agent, achieving clinical and radiological improvement with antifungal therapy.La neumonia de evolucion torpida son aquellas en que no se logra una respuesta clinica adecuada con el uso de terapia antimicrobiana. Existen multiples causas a esta falta de respuesta: resistencia antimicrobiana, microorganismos no cubiertos o infecciones por microorganismos atipicos. Coccidioides immitis es un hongo causante de neumonia en el hemisferio norte, especialmente en E.U.A y norte de Mexico. No existen reportes de casos pulmonares importados en Chile. Presentamos el caso de una mujer adulta con una neumonia que no respondio al tratamiento antimicrobiano habitual. Una vez realizado un estudio exhaustivo, se logro establecer mediante el estudio histopatologico la existencia de una coccidiodomicosis como entidad causal, logrando una respuesta clinica y radiologica favorable al tratamiento antifungico.