Rodrigo Cruz

Aislamiento ambiental de Sporothrix globosa en relación a un caso de esporotricosis linfo-cutánea

Resumen Introduccion: Sporothrix schenckii complex com-prende un grupo de hongos dimorfi cos ambientales que provocan esporotricosis. En Chile se han comunicado casos aislados en humanos; sin embargo, no se han descrito aislamientos de este hongo desde el ambiente. Objetivos: Orientados por un caso de esporotricosis linfo-cutanea en una paciente de 75 anos, se realizo un estudio ambiental para lograr el aislamiento de S. complex desde el suelo donde la paciente realizaba labores de horticultura. Materiales y Metodos: Se extrajo tierra y restos vegetales de cinco sectores donde la paciente efectuaba sus labores de horticultura. Se realizaron diluciones de tierras y siem-bra en agar Sabouraud con cicloheximida y cloranfenicol a 26oC. Los restos vegetales fueron sembrados directamente en el mismo medio. Las colonias sugerentes de S. complex se resembraron en agar PDA a 26oC y se identifi caron segun recomendacion de Marimon y cols. Resultados: De las diez placas del primer muestreo, una colonia de la siembra de tierra se identifi co como

Rinosinusitis alérgica por Curvularia inaequalis (Shear) Boedijn

Curvularia inaequalis (Shear) Boedijn es un hongo dematiaceo, saprofito y fitopatogeno, presente principalmente en areas tropicales y subtropicales, asociado a distintos sustratos organicos. Se ha identificado escasamente en infecciones sistemicas, cutaneas y solo existe una comunicacion de un caso de rinosinusitis alergica descrito anteriormente. Presentamos el caso clinico de un paciente con una rinosinusitis alergica fungica por Curvularia inaequalis (Shear) Boedijn en cuyo diagnostico se considero los sintomas y signos clinicos, la TAC de senos paranasales y el cultivo de la mucina. El paciente fue tratado con un aseo quirurgico por via endoscopica, ademas del uso de corticoesteroides inhalatorios e itra-conazol sistemico. Presento una buena respuesta clinica, encontrandose asintomatico a un ano del tratamiento.Curvularia inaequalis (Shear) Boedijn is a fungus dematiaceo, saprophyte and plant pathogen found mainly in tropical and subtropical areas, associated with various organic substrates. Rarely been identified in systemic infections, skin and there is only one report of allergic rhinosinusitis described above. A case of allergic fungal rhinosinusitis by Curvularia inaequalis (Shear) Boedijn in which diagnosis was considered the signs and symptoms, sinus CT and cultivation of mucin.The patient was treated with endoscopic surgical toilet, plus use of inhaled steroids and itraconazole systemic. With good clinical response, is asymptomatic at one year.

Guía para el diagnóstico de laboratorio de enfermedad fúngica invasora por hongos filamentosos

Early diagnosis and timely treatment are critical in Invasive Fungal Disease (IFD) caused by filamentous fungi in immunocompromised patients. Clinical features of IFD are nonspecific; therefore, images (CT scan), direct microscopic examination, staining and cultures of clinical samples and galactomannan determination in blood or BAL, are substantial. This guideline provides recommendations on transport and sample processing, including stains and culture media requirements. It also describes clues for diagnosis of major genera and species of Aspergillus.

Histoplasma capsulatum var. capsulatum Darling

Figura 1. Formas levaduriformes en biopsia de piel de paciente con histoplasmosis dise-minada. Tinción Gomori-Grocott. 100X. Figura 2. Macroaleuroconidios de colonia cultivada a 27 °C por 10 días. Tinción de lactofenol con azul de algodón. 100X.

Isolation of Cryptococcus gattii VGIII from feline nasal injury

Hereby we communicate the first autochthon isolation of Cryptococcus gattii VGIII in Chile, which was obtained from a nasal injury in a domestic cat in the Valparaíso region in Chile. The strain was identified using morphophysiological tests, MALDI-TOF, and URA5 gene PCR-RFLP analysis.

Infección pulmonar no invasora por Scedosporium apiospermum

We reported a case of non-invasive pulmonary infection by Scedosporium apiospermum in 67 years old female with bronchiectasis and caverns secondary to tuberculosis. Diagnosis was made with lung CT and bronchial lavage cultures. The patient was initially treated with itraconazole for six weeks without success and then voriconazole for 16 weeks, with good clinical response.

Enfermedad fúngica invasora (EFI) por hongos filamentosos en la Región de Valparaíso, Chile, desde la implementación del diagnóstico rápido de laboratorio

INTRODUCTION Invasive fungal diseases (IFD) by filamentous fungi are a common cause of morbidity and mortality in immunocompromised patients, especially those with myeloid leukemia. In 2011 a protocol for the rapid diagnosis of IFD by filamentous fungi was implemented in Valparaiso Region. OBJECTIVES To describe cases of IFD by filamentous fungi of the Valparaíso Region, since the implementation of rapid diagnosis and to compare results with the period 2004-2009. MATERIALS AND METHOD Descriptive and prospective study conducted in two public hospitals: Carlos van Buren at Valparaiso and Gustavo Fricke at Viña del Mar. We selected patients with a diagnosis of filamentous fungal diseases considering the EORTC/MSG criteria. Demographics, underlying diseases, risk factors for EFI, galactomannan (GM) results in blood and bronchoalveolar lavage, cultures and biopsies, treatment and overall lethality rates at 30 days were registered. RESULTS Eighteen patients were detected, 6 with proven and 12 probable IFD. Nine were diagnosed by GM, 8 by culture and two with both methods. In cases which the agent (9/18) was isolated from Rhizopus oryzae was the most frequent. When comparing overall lethality with the period 2004-2009, there was a reduction of 47.8%, which was statistically significant. CONCLUSIONS Compared to data previously published in the region, demographic and comorbidities of patients with IFD caused by filamentous fungi are similar, however the currently rapid diagnosis protocol has improved survival of patients and lethality experienced overall decrease.

Malassezia pachydermatis (Weidman) C.W. Dodge

INTRODUCTION Hepatic echinococcosis (HE) surgery is common in southerns Chile hospitals; however, related publications are scarce and with conflicting results, especially with regard to postoperative morbidity (POM), due to the diversity in it severity. The aim of this study is to determine POM in patients undergoing surgery for complicated HE (CHE). MATERIAL AND METHODS Case series part of a prospective cohort. Patients undergoing surgery for CHH in hospitals Hernán Henríquez Aravena hospital and Clínica Mayor of Temuco, between 2000 and 2012 were included. The main outcome variable was development of POM using the Clavien scale. Other variables of interest were hospital stay, mortality and recurrence. Descriptive statistics were applied and incidence of POM was determined. RESULTS 73 patients with a median age of 41 years and 58.9% female were studied. The median ultrasound diameter cysts were 15.0 cm. The average surgical time was 125.4 ± 26.3 min. The surgical procedure used most often was the pericystectomy (84.9%); and 84.9% of cases was performed concomitantly some other surgical procedure. The incidence of POM was 19.2%, 78.6% of whose cases were Grade I or II Clavien. The aetiology was 10.9% of medical complications and 8.2% of surgical complications. 1.4% of mortality was recorded; and with a median follow up of 97 months, no recurrence was verified. CONCLUSIONS POM in a cohort of patients with CHE is lower than the published and low severity. Subgroups with higher POM were: patients with coexistence of more than one complication, those with colangiohydatidosis and patients with liver abscess of hydatid origin.

Un sicario en un sanatorio de tuberculosis

n el ano 2006 cuando trabajaba en el Sanatorio de Tuberculosis de Penablanca, un dia ingreso acom-panado por Carabineros un paciente de 17 anos de edad, con tuberculosis pulmonar, quien habia abandonado en tres ocasiones el tratamiento y habia contagiado a toda su familia ademas de varias personas del vecindario en una poblacion vinamarina. Su conducta en el recinto fue muy provocativa y grosera, no se tomaba los medicamentos, se comia los alimentos de los otros pacientes, le robo la bata, pantu fl as y hasta el cepillo de dientes a un abuelito con tuberculosis multi-resistente. En varias ocasiones escupio el esquema de antes tratado e insulto a las paramedicos, enfermeras y amenazo con golpear a quien escribe estas letras. Lo converse con las autoridades del servicio de salud y con las fuerzas de orden sin obtener la mas minima ayuda. Asi fue como tuve que recurrir a Ravanal, un paciente con TBC pulmonar en fase bisemanal y BK (-), ex con-victo conocido en el hampa por multiples delitos, entre otros, la muerte por arma blanca de dos personas en una rina pasional en el centro de Villa Alemana. Le hable de lo dificil que era manejar a este paciente y el me dijo que lo habia observado todo, que lo sentia y que podria ayudar. “?Me podrias ayudar?” - le pregunte- “Si, ?quiere que lo mate?”- me respondio- “iComo se te ocurre eso!” -le dije –“Entonces, quiere que le pegue?” -me respondio-“iTampoco! no es la idea”- “Entonces, digame ?que quiere que le haga?”- me pregunto nuevamente –“Solo una amenaza y nada mas” le indique. Al dia siguiente de la conversacion, Ravanal presencio la conducta ya repetitiva del muchacho, ingreso a la sala de los pacientes aislados en la cohorte (+), lo tomo del cuello y lo elevo en el aire, saco su cuchillo de 35 cm y afi rmandola en el cuello le advirtio que desde ese momento debia portarse bien, tomarse sus medicinas y colaborar con el personal de salud. Desde ese dia aquel muchacho se convirtio en un ciu-dadano ejemplar, completo su tratamiento, los controles, colaboro con los otros pacientes, con los funcionarios, devolvio cada elemento obtenido indebidamente, barrio diariamente los pasillos y hasta hermoseo el deslucido jardin de aquel viejo sanatorio de tuberculosis.