María Eugenia Pinto C

Aspectos clínicos, etiología microbiana y manejo terapéutico de la parotiditis crónica recurrente infantil (PCRI)

Infantil chronic recurrent parotitis (PCRI) is a recurrent parotid swelling related to non-obstructive sialectasia. The aim of the study was to analyze the clinical features, microbiological aetiology and the response to local treatment. The study included 50 patients with PCRI and 20 controls without parotid swelling. The diagnosis was confirmed by sialography, and saliva samples were taken using aspiration post gland massage. Cultures with colony counts and serological samples for mumps virus were performed. Results: The average patient’s age was 5.6 years with no sex differences. All the patients had pain and 72% had fever, 49 of the 50 children had associated respiratory infections. 66% had purulent saliva, S. pneumoniae was isolated in 38% of cases, H. influenzae in 18%, and in 20% no organism was isolated. 48.1% of the S. pneumoniae were penicillin resistent. 3 patients and 2 controls had positive serology for mumps. 19 of the 50 patients had between 1 and 4 recurrences, 1 patient had 9 recurences. Treatment using intraglandular washing with a hydrosoluble substance produced remissions between 3 and 14 days, with disappearence of clinical signs. Only 5 patients needed antibiotics. Conclusion: PCRI is a complex infectious disease with recurrent episodes that affect the patient’s quality of life. Local treatment is useful in the control of this disease, decreasing the number of episodes and the use of antibiotics.

Control de infecciones por Staphylococcus aureus resistente a meticilina en una unidad de neonatologia

Control measures for a methicillin-resistant Staphylococcus aureus epidemic outbreak, in a neonatal unit of ametropolitan general hospital at Santiago, are described along with pertinent results. Control measures, includingpersonnel education, attention to hand wash ing techniques, strict isolation of all infected and colonized cases, pros-pective microbiological surveillance of newborns, healthcare workers and environment, together with eradicationof the agent from patients and personnel, were applied along a four month period and compared with the previousfour months. Colonization rates and the incidence of diseases caused by methicillin-resistant Staphylococcus aureusdecreased from 30.7 to 16% and 12.6 to 6.8%, respectively (p < 0.05),(Key words: Staphylococcus aureus, methicillin-resistant, neonatal infections, prevention.)

Detección de los genes de las exotoxinas pirogénicas SpeA, SpeB y SpeC en cepas chilenas de Streptococcus pyogenes y su asociación con la clínica

Background: The virulence of Streptococcus pyogenes is determined by a variety of structural molecules, toxins and complex enzymes. Pyrogenic exotoxins cause fever, erythematous reactions, cytotoxic and immunological effects. Aim: To assess the frequency of speA, speB and speC genes in Chilean Streptococcus pyogenes strains and their association with the invasiveness of infections. Material and methods: The genes for pyrogenic exotoxins SpeA, SpeB and SpeC were determined by polymerase chain reactions in 114 strains of group A Streptococcus pyogenes isolated from Chilean patients with invasive or non invasive infections. Results: The gene for SpeA was present in 30.7% of isolates, the gene for SpeB was present in 69.3% and the gen for SpeC in 44.7% of isolates. The gene for SpeA was present in 20 of 33 invasive infections and in 15 of 81 non invasive infections (p <0.0001). On the contrary, the gene for SpeC was present in 11 of 33 invasive infections and in 41 of 81 non invasive infections (p <0.05). The frequency of speB was similar in invasive and non invasive infections. Conclusions: There is a clear relationship between the presence of SpeA genes and the severity of infections caused by Streptococcus pyogenes. (Rev Med Chile 2000; 128: 27-34)

Vigilancia de susceptibilidad de cocáceas grampositivas a betalactámicos, glicopéptidos y otros antimicrobianos

Background: During the last decade, there has been a progressive increase in the resistance of gram (+) cocci to betalactamics and other antimicrobials. Therefore, vancomycin and teicoplanin have incorporated as alternative antimicrobial drugs. Aim: To assess the susceptibility of gram (+) cocci to different antimicrobials including vancomycin and teicoplanin. Material and methods: We studied 447 strains of gram (+) cocci coming from ambulatory and hospitalized patients. These included 308 Enterococcus sp strains, 99 Staphycoccus aureus strains and 40 coagulase negative Staphylococci strains. Enterococci susceptibility was measured using minimal inhibitory concentrations in agar and that of Staphylococci, through diffusion. Susceptibility to vancomycin and teicoplanin was measured using minimal inhibitory concentrations in all strains. Results: Enterococcus faecalis was 100% susceptible to ampicillin, penicillin, vancomycin and teicoplanin, 23% susceptible to tetracyclin and 47% to chloramphenicol. Susceptibility of E faecium was 61% to penicillin, 49% to chloramphenicol, 41% to tetracyclin, 100% to vancomycin and teicoplanin. Of 19 Enterococcus spp strains, 90% were susceptible to ampicillin, 80% to penicillin, 55% to chloramphenicol and 45% to tetracyclin. Only one E casseiflavus strain had a low level resistance to vancomycin and was susceptible to teicoplanin. No Staphylococcus aureus strain was resistant to vancomycin or teicoplanin. Conclusions: A permanent surveillance of gram (+) cocci antimicrobial susceptibility is required to update therapeutic schemes.

Control de calidad de los médicos que inician el ejercicio profesional en Chile: Declaración de la Academia Chilena de Medicina del Instituto de Chile

The Chilean Academy of Medicine supports the 2009 law by which all medical graduates from Chile as well as from foreign countries that wish to start their medical practice should have approved the National Board Examination in Medicine (“Eunacom”). Success in this examination of basic clinical knowledge and competences is mandatory to become attending physicians at the Public Health Care System and to apply to state-funded postgraduate education. Annually, about 90% Chilean graduates approve this examination, while no more than 20 % of foreign graduates do. Given the shortage of primary care physicians, some members of the Parliament have proposed to simplify the test or to exempt foreign medical graduates from it in order to broaden the coverage of primary care and decrease the waiting lists. The Chilean Academy of Medicine considers this shortcut strategy as dangerous for the Chilean population and unfair for our graduates. This Declaration has been sendto the National Health Authorities, to Deans of all Medical Schools, and to public press media.

Estudio de la actividad comparativa in vitro de telitromicina en patógenos respiratorios adquiridos en la comunidad en 13 centros clínicos chilenos

Two hundred eighty strains isolated from patients with respiratory infections, werestudied. The strains studied were S pneumoniae, penicillin sensitive (SPNS:57); intermediate(SPNI:35), resistant (SPNR:25); S pyogenes (SP:57); H influenzae (HIN 51); M catarrhalis(MC:25) and S aureus meticillin sensitive (SAUS:30). Minimal inhibitory concentration (MIC)by broth microdilution was studied for telitrhomycin and levofloxacin in all strains. Otherantimicrobials studied, but not in all strains were erythromycin, clindamycin, trimetoprimsulphamethoxazole, oxacillin, amoxicillin-clavulanic acid and cefuroxime.