Publications by authors named "Alberto Fica"

68 Publications

Cytomegalovirus infection in AIDS patients. An illustrative case series.

Rev Med Chil 2020 Jun;148(6):778-786

Laboratorio de Biología Molecular, Hospital Base de Valdivia, Valdivia, Chile.

Background: Cytomegalovirus (CMV) is an opportunistic infection (OI) in immunosuppressed patients. However, there are no clear cut-off values available for quantitative plasmatic CMV measures (viral load [VL]) to discriminate those with CMV illness from those infected suffering a transient viral reactivation.

Aim: To estimate a CMV VL cut-off point that discriminates infected patients and those with CMV related diseases, and to clinically characterize AIDS patients with this OI.

Patients And Methods: Retrospective analysis of AIDS patients admitted by any reason between years 2017 and 2019 and who had a positive plasma CMV VL at any titer. Cases were categorized with illness or infected using accepted criteria and the cut-off value was obtained by receiver operating characteristic curve (ROC) analysis.

Results: Twelve patients were identified as having a CMV-associated illness and seven with CMV infection. A CMV VL of 3,800 copies/mL had a sensitivity of 91.6% and 100% specificity to discriminate both states. Of the 12 patients with CMV illness, all were in AIDS stage and only five were receiving HIV therapy. Predominant clinical presentations were gastrointestinal (50%), followed by liver involvement (25%) and CMV disease (25%). All patients were treated with ganciclovir or valganciclovir. Ten patients had a favorable response (83.3%), one patient only had a laboratory improvement (8.3%) and one died during treatment (8.3%). Drug toxicity was recorded in nine patients but in only three cases, a dose adjustment was necessary.

Conclusions: The predominant clinical manifestation in our series was gastrointestinal. A CMV VL cutoff level of CMV VL of 3,800 copies / mL is useful to discriminate infected patients from those with CMV related disease.
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http://dx.doi.org/10.4067/S0034-98872020000600778DOI Listing
June 2020

[Hand cold abscess by a dematiaceous fungus. First report in Chile of Pleurostomophora richardsiae].

Rev Chilena Infectol 2020 Nov;37(5):604-609

Hospital Base de Valdivia, Valdivia, Chile.

Dematiaceous fungi are a heterogeneous group of microorganisms able to synthesize melanin. Infections by this group that provoke tissular hyphae are called phaeohyphomycosis and usually involve skin and neighbor tissues. We present the case of a 86 years old men with a progressive soft cystic tumor in his right hand and wrist not associated to pain or inflammatory signs. A surgical intervention demonstrated flexor tenosynovitis with serous secretion, pseudocapsule and synovitis. Fungal culture demonstrated a dematiaceous fungi compatible with Pleurostomophora richardsiae that was confirmed by sequencing of the ITS region. Biopsy showed chronic inflammation with granuloma and hyphae. After surgical drainage, the patient was discharged without antifungal therapy but died of unrelated causes three month later. This is the first description of P. richardsiae as a cause of phaeohyphomycosis in Chile, a country with a template climate. Phaeohyphomycosis can be suspected when a chronic skin cystic lesion involves extremities without inflammatory signs, sometimes with an associated fistula. It may affect immunocompetent or immunosuppressed patients. Treatment involves surgical excision with or without antifungal therapy and prognosis is favorable.
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http://dx.doi.org/10.4067/S0716-10182020000500604DOI Listing
November 2020

[Type I Brugada electrocardiographic pattern associated with Influenza B and fever. Report of a case].

Rev Med Chil 2020 Sep;148(9):1368-1370

Unidad Coronaria, Hospital Militar de Santiago, Santiago, Chile.

We report a 44-year-old male who was admitted for Influenza B and fever, presenting a type I Brugada pattern on the electrocardiogram. He evolved without cardiovascular symptoms. The pharmacological test with intravenous Procainamide reproduced type I Brugada pattern and the programmed electrical stimulation was negative for ventricular arrhythmias. He was discharged without incidents. Clinical aspects of Brugada syndrome and the importance of fever are discussed in the current context of the COVID-19 pandemic.
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http://dx.doi.org/10.4067/S0034-98872020000901368DOI Listing
September 2020

Penicillin desensitization in allergic pregnant women with syphilis. Report of two cases.

Rev Med Chil 2020 Mar;148(3):344-348

Servicio de Ginecología y Obstetricia, Hospital Base de Valdivia, Valdivia, Chile.

Syphilis during pregnancy has a high risk of congenital transmission with disastrous fetal consequences. Penicillin (PNC) is the only effective antimicrobial for the treatment of pregnant women with syphilis. Chilean guidelines do not consider desensitization to PNC in these women. We report two cases of pregnant women aged 32 and 23 years, with immediate allergy to PNC and syphilis who were safely and successfully desensitized using a four-hour intravenous protocol in the critical care unit and who subsequently received benzathine G PNC. An electronic survey was conducted among approximately 100 Clinical Pharmacists (CP) in the country. Of these, 16 answered and 13 reported having experience in drug desensitization, in at least five cases with PNC and none reported deaths or cardiorespiratory arrest. Desensitization to PNC can be carried out safely and in Chile, this alternative should be incorporated to the management of pregnant women with syphilis and immediate allergy to PNC, instead of using erythromycin.
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http://dx.doi.org/10.4067/S0034-98872020000300344DOI Listing
March 2020

Infectious endocarditis by Bartonella species. Report of two cases.

Rev Med Chil 2019 Oct;147(10):1340-1345

Subdepartamento de Medicina, Hospital Base de Valdivia, Valdivia, Chile.

Infectious endocarditis (IE) by Bartonella species is an emerging problem worldwide. We report two cases of native valve Bartonella-associated IE events, both affecting adult male patients with a history of alcohol abuse and a low socioeconomic status. Admissions were due to pancytopenia and bleeding in one case and embolic stroke in the other. Blood cultures were negative and IgG indirect immunofluorescence assays (IFA) were positive for B. henselae/B. quintana in high titers (1/16,384-1/16,384, and 1/32,768 -1/16,384, respectively). Cases were classified as definitive IE events according to modified Duke criteria due to the presence of valve vegetations with at least three minor criteria. One patient required aortic mechanical valve replacement and survived, and the other died after a massive hemorrhagic transformation of his stroke. PCR amplification and sequencing of the 16S ribosomal bacterial DNA from a valve tissue sample obtained at surgery in the patient who survived, confirmed B. quintana as the etiological agent. Bartonella-associated IE is an emerging problem in Chile, present in disadvantaged populations. It should be suspected in patients with culture-negative IE. IFA does not discriminate between B. henselae and B. quintana infection, but high titers suggest IE. Complementary PCR techniques may help to elucidate the final causative agent.
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http://dx.doi.org/10.4067/s0034-98872019001001340DOI Listing
October 2019

[Encephalitis caused by type B influenza virus in an adult. Report of one case].

Rev Med Chil 2019 Jul;147(7):922-927

Laboratorio de Biología Molecular, Hospital Base de Valdivia, Valdivia, Chile.

Neurological manifestations associated with influenza virus infection include encephalitis, encephalopathy, acute necrotizing encephalitis, transverse myelitis, acute disseminated encephalomyelitis, mild encephalitis with reversible splenial syndrome (MERS), and Guillaín Barré syndrome. We report a 16-year-old female who was admitted at our emergency department with seizures, confusion, nystagmus and motor clumsiness five days after an upper a respiratory tract infection. Influenza type B virus infection was confirmed by chain polymerase reaction analysis. The initial electroencephalogram demonstrated a pattern of global slowness without epileptic discharges. One week later, it showed a progression to slow-wave focal bilateral discharges at both temporal and occipital lobes. The patient had a favorable evolution and was discharged 19 days after admission with phenytoin to prevent seizures.
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http://dx.doi.org/10.4067/S0034-98872019000700922DOI Listing
July 2019

Host characteristics predict outcome among adult patients admitted by severe acute respiratory infection.

Rev Med Chil 2019 Jul;147(7):842-851

Laboratorio Central, Hospital Militar de Santiago, Santiago, Chile.

Background: Except for influenza pandemics, different observational studies have failed to demonstrate differences in mortality between various etiologies in adult patients hospitalized for respiratory infections.

Aim: To compare clinical and mortality differences between different viral pathogens associated with severe acute respiratory infections (SARI) in hospitalized adults.

Material And Methods: One-year prospective study in a sentinel center. We included 132 patients with SARI hospitalized for any of the nine viruses under study by PCR. Clinical variables were compared, excluding cases of coinfection.

Results: A viral coinfection was identified in 12% and influenza infection in 56% of cases. Eighty percent of patients were aged ≥ 65 years, with a high frequency of comorbidities, 27% were bedridden. Twenty four percent were admitted to critical care units, 20% required ventilatory assistance and 16% died. Cases occurred throughout the year, with an expected seasonal peak between autumn and spring and a predominance of infections not associated with influenza during summer months. In the multivariate analysis, only being bedridden was significantly associated with mortality at discharge (Odds ratio 23.46; 95% confidence intervals 3.33-165.12, p < 0.01), without association with age, comorbidity, viral pathogen involved, laboratory parameters, clinical presentation or CURB65 score. No major clinical dissimilarities were found between different viral pathogens.

Conclusions: In our series of patients, mostly elderly, only bedridden status was significantly associated with mortality at discharge in patients hospitalized for SARI. Viral pathogens were not relevant.
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http://dx.doi.org/10.4067/S0034-98872019000700842DOI Listing
July 2019

[Worsening situation of tuberculosis in Chile].

Rev Med Chil 2019 Aug;147(8):1042-1052

Centro de Epidemiología y Políticas de Salud, Universidad del Desarrollo, Santiago, Chile.

Background: Recent data suggest an increase in tuberculosis (TB) incidence in Chile.

Aim: To evaluate recent epidemiological trends, geographic extension and potential factors associated with TB reemergence in Chile.

Material And Methods: Data analysis from official sources and trend analysis.

Results: TB incidence rate increased from 12.3 (2014) to 14.7 (2017) per 100,000 inhabitants. Morbidity rates also increased in nine out of 15 regions. The proportion of TB cases in specific groups has also increased in the last six years: HIV/AIDS (68%), immigrants (118%), drug users/alcoholics (267%) and homeless people (370%). Several indicators of the national TB program performance have deteriorated including TB case detection, HIV co-infection study and contact tracing activities. Overall results indicate a higher than expected case-fatality ratio (> 3%), high rates of loss from follow-up (> 5%), and low percentage of cohort healing rate (< 90%). This decline is associated with a Control Program with scarce human resources whose central budget decreased by 90% from 2008 to 2014. New molecular diagnostic tools and liquid media culture were only recently implemented.

Conclusions: TB trends and overall program performance indicators have deteriorated in recent years in Chile and several factors appear to be involved. Multiple strategies will be required to rectify this situation.
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http://dx.doi.org/10.4067/S0034-98872019000801042DOI Listing
August 2019

[Chilean strains of clinical origin of non-O1, non-O139 Vibrio cholerae carry the genes vcsN2, vcsC2, vcsV2, vspD, toxR2 y vopF from secretion system T3SS2 present in an island of pathogenicity].

Rev Chilena Infectol 2019 Jun;36(3):312-317

Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.

Backgound: The virulence factors of the Vibrio cholerae non-O1, non-O139 strains are not clearly known. The strain of septicemic origin NN1 Vibrio cholerae non-O1, non-O139 was sequenced previously by the Illumina platform. A fragment of the pathogenicity island VPaI-7 of V. parahaemolyticus was detected in its genome.

Aim: To detect the virulence genes vcsN2, vcsC2, vcsV2, vspD, toxR2 y vopF in Chilean strains of V. cholerae non-O1, non-O139.

Methods: A total of 9 Chilean strains of clinical origin of Vibrio cholerae non-O1, non-O139 isolated between 2006-2012 were analyzed by conventional PCR assays for type III secretion genes encoded on that island: vcsN2, vcsC2, vcsV2, vspD, toxR2 and vopF. Additionally, the presence of the virulence genes hylA and rtxA was determined. In addition, REP-PCR and ERIC-PCR assays were performed.

Results: most (6/9) Chilean V. cholerae non-O1, non-O139 strains contain the type III secretion genes vcsN2, vcsC2, vcsV2, vspD, toxR2 and vopF, encoded in an island of pathogenicity. In addition, all (9/9) the strains contain the virulence genes hylA and rtxA.

Conclusion: These results strongly suggest the possibility that those strains possess an important virulence potential in humans.
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http://dx.doi.org/10.4067/S0716-10182019000300312DOI Listing
June 2019

[Aseptic meningitis associated to mumps during an epidemic outbreak].

Rev Chilena Infectol 2019 Feb;36(1):106-111

Hospital Base de Valdivia, Valdivia, Chile.

We report two cases of acute aseptic meningitis associated to mumps in middle-aged women, one pregnant. Both presented shortly after parotid gland enlargement. Neurological complications were suspected by headache, fever and meningeal signs and confirmed by CSF findings (mononuclear predominant pleocytosis) with negative results for alternative causes. Mumps were confirmed by positive IgM and IgG serology. Both patients were discharged with a favorable evolution and complete disappearance of symptoms. Cases were concurrent with a regional mumps outbreak. Conclusions: Aseptic meningitis is a rare mumps-associated neurological complication. Its diagnostic can be achieved by precedent parotid enlargement, mononuclear pleocytosis in the CSF and positive IgM and IgG serology or viral detection by PCR in urine or salivary samples. This complication would be more probably observed during mumps outbreaks.
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http://dx.doi.org/10.4067/S0716-10182019000100106DOI Listing
February 2019

Fatal nosocomial hemorrhagic enterocolitis probably caused by adenovirus. Report of one case.

Rev Med Chil 2019 Feb;147(2):256-260

Servicio de Anatomía Patológica, Hospital Militar de Santiago, Santiago, Chile.

Adenovirus (ADV) is a recognized cause of severe disease among immunocompromised patients. We report a previously healthy 39-year-old female, admitted with influenza pneumonia and evolving with lung hemorrhage and acute renal failure requiring mechanical ventilation and hemodialysis. She received high corticosteroid doses due to an initial suspicion of alveolar hemorrhage. Lymphopenia already present before steroid use (567/μL), was maintained during the whole hospital stay (mean 782/μL). From the second week of admission she presented a high-volume diarrhea (mean 2.5 L/day) associated to intermittent bloody stools. An ulcerative enterocolitis was confirmed by CT images and colonoscopy. ADV was detected in a colonic tissue sample by real time PCR but not by a commercial filmarray test. Cidofovir-probenecid and racecadotril therapy were indicated without changing the clinical course of diarrhea and the patient finally died.
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http://dx.doi.org/10.4067/s0034-98872019000200256DOI Listing
February 2019

Severe acute respiratory infections (SARI) from influenza in adult patients in Chile: the experience of a sentinel hospital.

Rev Panam Salud Publica 2019 25;43:e1. Epub 2019 Jan 25.

School of Medicine, Universidad Austral de Chile-Campus Isla Teja, Valdivia, Chile.

Objective: To 1) describe clinical characteristics of adult patients in Chile with severe acute respiratory infections (SARI) associated with influenza viruses, and 2) analyze virus subtypes identified in specimens collected from those patients, hospital resources used in clinical management, clinical evolution, and risk factors associated with a fatal outcome, using observational data from the SARI surveillance network (SARInet).

Methods: Adults hospitalized from 1 July 2011 to 31 December 2015 with influenza-associated SARI at a SARI sentinel surveillance hospital in Santiago were identified and the presence of influenza in all cases confirmed by reverse transcription polymerase chain reaction (RT-PCR), using respiratory samples.

Results: A total of 221 patients (mean age: 74.1 years) were hospitalized with influenza-associated SARI during the study period. Of this study cohort, 91.4% had risk factors for complications and 34.3% had been vaccinated during the most recent campaign. Pneumonia was the most frequent clinical manifestation, occurring in 57.0% of the cohort; other manifestations included influenza-like illness, exacerbated chronic bronchitis, decompensated heart failure, and asthmatic crisis. Cases occurred year-round, with an epidemic peak during autumn-winter. Both influenza A (H1N1pdm09 and H3N2) and B virus co-circulated. Critical care beds were required for 26.7% of the cohort, and 19.5% needed ventilatory assistance. Multivariate analysis identified four significant factors associated with in-hospital mortality: 1) being bedridden (adjusted odds ratio (aOR): 22.3; 95% confidence interval (CI): 3.0-164); 2) admission to critical care unit (aOR: 8.9; CI: 1.44-55); 3) Pa0/Fi0 ratio < 250 (aOR: 5.8; CI: 1.02-33); and 4) increased serum creatinine concentration (> 1 mg/dL) (aOR: 5.47; CI: 1.20-24). Seasonal influenza vaccine was identified as a significant protective factor (aOR: 0.14; CI: 0.021-0.90).

Conclusions: Influenza-associated SARI affected mainly elderly patients with underlying conditions. Most patients evolved to respiratory failure and more than one-quarter required critical care beds. Clinical presentation was variable. Death was associated with host characteristics and disease-associated conditions, and vaccine was protective. Virus type did not influence outcome.
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http://dx.doi.org/10.26633/RPSP.2019.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393720PMC
January 2019

[Cerebral cryptococcosis and immune reconstitution inflammatory syndrome. Case report].

Rev Med Chil 2018 Dec;146(12):1481-1485

Subdepartamento de Medicina, Hospital Base de Valdivia, Valdivia, Chile.

We report a 45-year-old male with AIDS who had a Cryptococcus neoformans central nervous system infection. He was treated with amphotericin B deoxycholate subsequently changed to voriconazole due to systemic toxicity of the former. Plasma levels of voriconazole were insufficient with a standard dose (0.7 μg/mL), therefore, the dose was increased thereafter to reach appropriate levels (4.5 μg/mL). Anti-retroviral therapy was started five weeks after voriconazole initiation with non-interacting drugs and he was discharged after a favorable evolution. He was re-admitted three months later due to seizures; a brain magnetic resonance showed new sub-cortical nodules. After excluding alternative causes and demonstrating fungal eradication, an immune reconstitution inflammatory syndrome (IRIS) event was suspected and treated with a short course of steroids. His evolution was satisfactory.
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http://dx.doi.org/10.4067/s0034-98872018001201481DOI Listing
December 2018

Long-term impact of competitive biddings and an antimicrobial stewardship program in a general hospital in Chile.

Rev Med Chil 2018 Sep;146(9):968-977

Unidad Bioestadística, Hospital Militar de Santiago, Santiago, Chile.

Background: The long-term effect of an antimicrobial stewardship program (ASP) and its integrated impact with competitive biddings have been seldom reported.

Aim: To evaluate the long-term effect of an ASP on antimicrobial consumption, expenditure, antimicrobial resistance and hospital mortality. To estimate the contribution of competitive biddings on cost-savings.

Material And Methods: A comparison of periods prior (2005-2008) and posterior to ASP initiation (2009 and 2015) was done. An estimation of cost savings attributable to ASP and to competitive biddings was also performed.

Results: Basal median antimicrobial consumption decreased from 221.3 to 170 daily defined doses/100 beds after the start of the ASP. At the last year, global antimicrobial consumption declined by 28%. Median antimicrobial expenditure per bed (initially US$ 13) declined to US$ 10 at the first year (-28%) and to US$ 6 the last year (-57%). As the reduction in consumption was lower than the reduction in expenditure during the last year, we assumed that only 48.4% of savings were attributable to the ASP. According to antimicrobial charges per bed from prior and after ASP implementation, we estimated global savings of US$ 393072 and US$ 190000 directly attributable to the ASP, difference explained by parallel competitive biddings. Drug resistance among nosocomial bacterial isolates did not show significant changes. Global and infectious disease-associated mortality per 1000 discharges significantly decreased during the study period (p < 0.05).

Conclusions: The ASP had a favorable impact on antimicrobial consumption, savings and mortality rates but did not have effect on antimicrobial resistance in selected bacterial strains.
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http://dx.doi.org/10.4067/s0034-98872018000900968DOI Listing
September 2018

[Exposure to risk fluids in health personnel. Evaluation of direct costs in their management].

Rev Chilena Infectol 2018;35(5):490-497

Unidad de Infecciones Asociadas, Atención de Salud Hospital Militar de Santiago, Santiago, Chile.

Background: Health personnel are exposed to accidents with blood and other potentially infectious biological fluids in their clinical practice. Management of these events has high costs that are likely to be reduced.

Aim: To give a general description of work accidents and their associated costs.

Material And Method: All healthcare workers reports of exposure to blood or risk fluids between 2010 and 2015, were included. Health care costs were calculated. Records were analyzed in a retrospective manner.

Results: 189 exposures to risk fluids were reported during the study period with an average of 31 accidents per year. 83.5% of the studied sources were negative for HIV, HBV and HCV, 12.6% was with unknown source and only 3.7% was positive for any of them. The costs associated with management of risk exposures was $ 2,765,890 Chilean pesos/year (4,274 USD). The average cost per event was $ 73,171 Chilean pesos (113 USD). Approximately 80% of this figure corresponds to basic management protocol.

Conclusion: Exposure to risk fluids in health personnel is frequent and has a high cost. This cost can be reduced by the application of prevention measures to give the healthcare workers a safer environment for their daily practice.
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http://dx.doi.org/10.4067/s0716-10182018000500490DOI Listing
August 2019

[Cost evaluation of ventilator-associated pneumonia in adult patients in a general hospital in Chile].

Rev Chilena Infectol 2017 Oct;34(5):447-452

Unidad de Infecciones Asociadas a la Atención de Salud, Hospital Militar de Santiago, Chile.

Background: Ventilator-associated pneumonia (VAP) is an adverse event that increases morbidity, mortality and costs due to a prolonged stay and requirement of microbiological studies and antimicrobial therapy. There is not recent data of VAP costs in Chile.

Aim: To evaluate additional costs in adult patients with VAP compared to controls in a general hospital in the Metropolitan Area.

Patients And Methods: Use of the PAHO paired casecontrol protocol for cost evaluation associated to nosocomial infections and estimation of cost in excess per VAP event. Length of stay (LOS) in excess, antimicrobial consumption in daily-defined doses (DDD), and number of microbiological studies were compared between both groups.

Results: From 2012 to 2015, 18 patients with VAP events were identified with their respective controls. LOS exceeded 6.1 days on average among patients with VAP respect to controls (p < 0.05). DDD was higher among patients with VAP (difference 11.7 DDD) as well as number of cultures (3.2 higher on average, p < 0.05). Cost in excess per VAP event reached 4,475 USD.

Conclusions: In our Centre, VAP events are associated to a higher LOS, antimicrobial consumption and microbiological studies.
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http://dx.doi.org/10.4067/S0716-10182017000500447DOI Listing
October 2017

[Meningitis and hypoacusia due to swine meat handling].

Rev Chilena Infectol 2018;35(6):731-732

Hospital Base de Valdivia, Chile.

Zoonotic meningitis by Streptococcus suis has been described occasionally in Chile and linked to pig farmers in the south of the country. We report a female case that developed acute bacterial meningitis by this agent, two days after handling a piece of raw swine meat. She did not participate on swine breeding nor visited farms. Diagnosis was obtained by CSF culture. A severe hearing loss and not recovered despite corticosteroids use and antimicrobial treatment, without others complications. Meningitis by S. suis is emerging as a new pathogen and linked to swine in different forms. Hypoacusis happens frequently with this agent.
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http://dx.doi.org/10.4067/S0716-10182018000600731DOI Listing
August 2019

[Hansen disease, an emergent condition in Chile].

Rev Chilena Infectol 2018;35(6):722-728

Programa Control y Eliminación Tuberculosis, MINSAL, Santiago, Chile.

Hansen's disease (HD) is caused by Mycobacterium leprae. It has a chronic course and preferentially affects the skin and the peripheral nerves. It's an emergent infection in Chile due to migration waves. This case report affecting a migrant worker from Haiti that presented several compatible skin lesions, with hypoesthesia and unilateral madarosis that appeared before arrival. The diagnosis of a multibacillary form was established by clinical findings, presence of fast acid bacilli on a direct skin smear, and inflammatory cell surrounding nerve endings and granulomas on skin biopsy. Besides, specific rpoB and hsp65 gene segments from M. leprae were amplified from skin samples. Patient was treated with the WHO standard combined regimen for multibacillary forms during one year showing partial regression of skin lesions. Nasopharyngeal samples showed the presence of M. leprae rpoB copies detected by PCR decreasing until six months of therapy. Notifiable diseases databases showed a recent increment of cases, all related to migrant population. Hansen's disease is a new condition in Chile and clinicians should be aware of this possibility. Molecular tools may facilitate diagnosis and follow up.
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http://dx.doi.org/10.4067/S0716-10182018000600722DOI Listing
August 2019

[Impact on social networks after announcement of a case of Hansen's disease in an immigrant in Chile].

Rev Chilena Infectol 2018;35(6):689-694

Hospital Base de Valdivia, Valdivia, Chile.

Background: Hansen's disease (HD) is a curable disease of low transmissibility which doesn't need social segregation or public notice. The announcement of a HD case in an immigrant by a governmental medical employee allowed to evaluate its impact within social networks (SN) in Chile, a country without endemic cases.

Aim: To measure the impact and tone of mentions within SN after the announcement of an imported case.

Methods: Mention analysis from -21 to +21 days of the notice using commercial software. Mentions were assigned to a positive, neutral or negative tone and net feeling calculated according to established formula.

Results: The day of the announcement immigrant mentions concentrated on HD (45%) and tone was distributed almost equally between positive and negative mentions but net feeling analysis indicated predominance of negative values the first day and a dynamic oscillation thereafter. A net negative feeling was registered at least during 3 different dates.

Conclusions: Announcement of a HD case hoarded immigrant mentions towards this disease with a significant fraction of negative comments within SN. Because, there is no public health justification to divulgate this disease, this negative impact generated by an official clerk, could has been avoided. Analysis of SN is a useful tool to explore an infectious disease impact on public opinion.
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http://dx.doi.org/10.4067/S0716-10182018000600689DOI Listing
August 2019

[Infectious or noninfectious phlebitis: lessons from a an interventional programm on phlebitis associated to peripheral venous catheter].

Rev Chilena Infectol 2017 Aug;34(4):319-325

Servicio de Farmacia, Hospital Militar de Santiago, Chile.

Background: There is no consensus definition to distinguish infectious from non-infectious phlebitis associated to peripheral venous catheter.

Aims: To evaluate the impact of an intervention program on the rate of infectious (those associated to bacteremia or local purulent discharge) and non-infectious phlebitis (the rest) and identify differential features.

Methods: Interventional study developed in three stages: basal measurement, intervention, and evaluation.

Results: Ten infectious and 186 non-infectious phlebitis were registered. Infectious phlebitis diminished after intervention (0.2 to 0.04 events per 1,000 bed-days; p = 0.02) but not the rest (2.3 per 1,000 bed-days before and after). Five of 10 patients with infectious phlebitis had bacteremia, one with infectious endocarditis and valve replacement, and other with septic shock and a fatal outcome. None of the patients in the non-infectious group presented complications. Infectious phlebitis appeared later (mean 4.1 versus 2.4 days; p = 0.007) and were associated to fever (40% vs 5.9%, p = 0.004). Non-infectious phlebitis was associated to irritating compounds (OR 6.1; IC95 1.3-29, p < 0.05).

Conclusions: The intervention program demonstrated a favorable impact only on the rate of infectious phlebitis. Distinction appears to be relevant because those of infectious origin are associated with fever, complications or death, respond to an intervention program, and emerge lately.
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http://dx.doi.org/10.4067/s0716-10182017000400319DOI Listing
August 2017

[Tetanus after cat scratch and bites in a previously immunized patient].

Rev Chilena Infectol 2017 Apr;34(2):181-185

Universidad de los Andes, Chile.

Tetanus is declining due to vaccination, professional labor management and appropriate wound care. Tetanus cases have been reported despite immunization. We report the case of a previously healthy 21 years old female patient that presented a mild generalized tetanus requiring admission after mild and recurrent cat scratch and bites. She had received six vaccine shots during childhood, and a booster dose five years earlier after a rabbit bite. Symptoms appeared seven weeks after the last contact, and included headache, muscle spasms and mild opisthotonus. Laboratory evaluation, including CSF analysis and microbiological investigation, as well as imaging studies were all normal. The patient received 6,000 IU of human antitoxin immunoglobulin. No autonomic manifestations or respiratory compromise were registered. Symptoms resolved rapidly and she was discharge after seven days with an order to complete a tetanus toxoid immunization schedule with three doses.

Conclusions: Tetanus is possible in urban settings with a declining epidemiologic curve of disease in previously immunized patients. Severity of disease is modulated by previous vaccination.
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http://dx.doi.org/10.4067/S0716-10182017000200012DOI Listing
April 2017

[Acute glomerulonephritis with hemodialysis requirement secondary to influenza A H1N1pdm09 infection: Report of two cases].

Rev Chilena Infectol 2017 Feb;34(1):81-86

Servicio de Nefrología, Hospital Militar, Santiago, Chile.

Acute renal failure (ARF) requiring hemodialysis is not common among patients affected by influenza. We report two unvaccinated adult patients with smoking habit, which were admitted with severe influenza A H1N1pdm09 that evolved with shock and required mechanical ventilation. Both patients developed progressive renal failure with oliguria/anuria, associated with urinary of inflammatory sediment with proteinuria, microhematuria and in one case also with hypocomplementemia, suggesting acute glomerulonephritis. Renal replacement therapy (RRT) was required in both cases. In one patient, who died of late complications, sequencing of the HA1 segment revealed the previously described D222N mutation associated to severe cases. ARF with RRT appears to be an uncommon complication of patients hospitalized for influenza A H1N1pdm09 and may be secondary to acute glomerulonephritis.
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February 2017

[Chagas disease affecting the central nervous system in a patient with AIDS demonstrated by quantitative molecular methods].

Rev Chilena Infectol 2017 Feb;34(1):69-76

Servicio de Neurología, Hospital Militar, Santiago, Chile.

Although infrequent, Trypanosoma cruzi reactivation is possible among patients with HIV/AIDS infection that develop a tumor-like or granulomatous lesion in the CNS. We report the case of a 60 years old male patient with HIV/AIDS and low CD4 lymphocytes count with cerebellar symptoms and mild paresis, associated to supra and infratentorial hypodense lesions and positive serology tests both to T. gondii and Trypanosoma cruzi. Empirical therapy against toxoplasmosis was prescribed together with antiretroviral therapy but without a favorable response. Brain Chagas disease was confirmed by quantitative PCR in the CSF but he died despite nifurtimox treatment. Despite its rare occurrence, Chagas disease affecting the CNS is possible among patients with HIV/AIDS infection. Epidemiological exposure, a positive Chagas serological test and the image pattern of brain lesions support the suspicion. Diagnosis can be confirmed by molecular test in CSF samples, including new quantitative methods. Despite an adverse prognosis, specific therapy can be attempted besides antiretroviral treatment.
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February 2017

[Exposition to total parenteral nutrition increases the risk of catheter-related bloodstream infection].

Rev Chilena Infectol 2016 Dec;33(6):603-608

Unidad de Infecciones Asociadas a la Atención de Salud, Hospital Militar de Santiago, Chile.

Background: Infectious complications associated to central venous catheter (CVC) increase morbidity, mortality and costs. Total parenteral nutrition (TPN) is one of the risk factors described for catheter-related bloodstream infection (CR-BSI). The aim of this study was explore if TPN and time of exposition, are risk factors for CR-BSI among patient exposed to this therapy.

Patients And Methods: Cohort study of patients with CVC exposed and not exposed to TPN with calculation of the relative risk (RR) for CR-BSI and percentage of CR-BSI according to different times of exposition to TPN. Study encompassed years 2010-2015 and only adult patients were included.

Results: During the study period 51 events of CR-BSI were identified, with 27 occurring among those exposed to TPN and 24 among those not exposed. CR-BSI incidence rate was 6.3 in the group with TPN and 1.2 in those without this therapy (RR 5.4; IC 95 3.6-8.2). The percentage of patients with CR-BSI increased in parallel to exposition time (Pearson coefficient +0.91) and the OR increased for expositions ≥ 7 days (OR 2.8; IC 95 1.047.4; p < 0.05).

Conclusions: Exposition to TPN increases the risk to CR-BSI in adult patients with CVC and this risk raise with exposition time.
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http://dx.doi.org/10.4067/S0716-10182016000600001DOI Listing
December 2016

[Strategies to protect the newborn and infants under 6 months of age against pertussis: Statement of the Advisory Committee for Immunizations of the Chilean Infectious Diseases Society].

Rev Chilena Infectol 2016 Oct;33(5):543-546

In recent years there have been Pertussis outbreaks not seen in the last 50 years affecting adults, adolescents and children and causing deaths in young unvaccinated infants. In Chile an outbreak of Pertussis started in year 2011, leaving 16 infants less than 3 months dead during this year, twice the number seen in a non epidemic year. These children were infected before receiving the programmatic vaccines indicated at 2, 4 and 6 months of age, usually from close contacts, especially their mothers. Pertussis control has not been possible for several reasons, such as limited immunity duration of available vaccines and their poor impact on nasopharyngeal carriage, situation that keeps the agent's circulation and transmission, condition often asymptomatic or unrecognized. Additionally, the use of acellular vaccines appears to be a determining factor because they induce an immune response with poor immune memory and consequently a short time duration. The acellular vaccines with reduced antigen content, available for adolescents and adults, has allowed the evaluation of various strategies but none has succeeded in reducing infant mortality. Recently a new strategy of vaccinating pregnant women against Pertussis in the second or third semester has shown remarkable results reducing up to 90% infant deaths due to Pertussis infection. This strategy prevents mother's infection avoiding child infection through respiratory droplets and also provides the child with antibodies from placental transmission. Improved pertussis vaccines are required, in the meantime the Committee considers that the pregnant immunization strategy, between the 27 and 36 weeks, with acellular pertussis vaccine should be included in our national vaccine program.
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October 2016

[Reasons to recommend vaccination against dengue in Easter Island: Immunization Advisory Committee of Sociedad Chilena de Infectología].

Rev Chilena Infectol 2016 Aug;33(4):452-454

Dengue was first diagnosed on Easter Island on year 2002 and thereafter recurrent outbreaks have occurred involving different serotypes of dengue virus. Its vector, Aedes aegypti has not been eliminated despite the small size of the island. Conditions at the local hospital preclude adequate management of severe and hemorrhagic cases due to the absence of a Critical Care Unit as well as no availability of platelets, or plasma units for transfusion. Besides, transfer, of severely affected patients to continental Chile is cumbersome, slow and expensive. In this scenario, it is advisable to implement selective vaccination of Easter Island habitants with an available quadrivalent attenuated dengue vaccine with the aim to reduce hemorrhagic and severe dengue cases. This strategy should not replace permanent efforts to control waste disposal sites, water sources, maintain vector surveillance and increase education of the population.
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August 2016

[Gastos hospitalarios por neumonía neumocóccica invasora en adultos en un hospital general en Chile].

Rev Chilena Infectol 2016 Aug;33(4):389-394

Pneumococcal infections are important for their morbidity and economic burden, but there is no economical data from adults patients in Chile.

Aims: Estimate direct medical costs of bacteremic pneumococcal pneumonia among adult patients hospitalized in a general hospital and to evaluate the sensitivity of ICD 10 discharge codes to capture infections from this pathogen.

Methods: Analysis of hospital charges by components in a group of patients admitted for bacteremic pneumococcal pneumonia, correction of values by inflation and conversion from CLP to US$.

Results: Data were collected from 59 patients admitted during 2005-2010, mean age 71.9 years. Average hospital charges for those managed in general wards reached 2,756 US$, 8,978 US$ for those managed in critical care units (CCU) and 6,025 for the whole group. Charges were higher in CCU (p < 0.001), and patients managed in these units generated 78.3% of the whole cost (n = 31; 52.5% from total). The median cost in general wards was 1,558 US$, and 3,993 in CCU. Main components were bed occupancy (37.8% of charges), and medications (27.4%). There were no differences associated to age, comorbidities, severity scores or mortality. No single ICD discharge code involved a S. pneumoniae bacteremic case (0% sensitivity) and only 2 cases were coded as pneumococcal pneumonia (3.4%).

Conclusions: Mean hospital charges (~6,000 US dollars) or median values (~2,400 US dollars) were high, underlying the economic impact of this condition. Costs were higher among patients managed in CCU. Recognition of bacteremic pneumococcal infections by ICD 10 discharge codes has a very low sensitivity.
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August 2016

[Spondylodiscitis: clinical experience in a Chilean general hospital].

Rev Chilena Infectol 2016 Jun;33(3):322-30

Laboratorio de Microbiología, Departamento de Medicina, Hospital Militar de Santiago, Chile.

Background: Spondylodiscitis (SD) involves long periods of hospitalization, diagnostic latency and risk of long-term complications. No updated series are available in Chile and a change in demographic features and etiology is suspected.

Aim: To characterize a group of patients with SD.

Patients And Methods: Clinical series including patients over an 8 year period.

Results: We identified 37 patients; 37.8% women and 62.2% men (mean age 66.8 years); 64.9% were elderly; 35.1% had diabetes and 21.6% urological comorbidity. Main symptoms were pain and fever. Erythrocyte sedimentation rate was elevated in 89.2%, and 86.5% patients had MRI, which was always confirmatory. Lumbar spine was the most common site of infection (43.2%). Etiology was identified in 28/37 patients: 71.4% yielded grampositive cocci (Staphylococcus aureus predominantly), Mycobacterium tuberculosis was identified in only 10.7%. Staphylococcus aureus was associated to medical comorbidities (p < 0,05) and gramnegative bacilli to hepatobiliar or intestinal symptoms (p < 0,05). Culture obtained by a surgical procedure had the highest yield. The average duration of antibiotic therapy was 63.8 days (IQR 53-72). Treatment-related side effects were detected in 18.9% of patients. The average hospital stay was 38.9 days. No deaths occurred during hospitalization. Motor sequelae were present in 18.9% of this series.

Discussion: Most patients with SD were older adults. Staphylococcus aureus was predominant and M. tuberculosis was uncommon. Antibiotic side effects were relevant as well as the neurological complications.
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June 2016

[Statement of the Advisory Immunization Committee of the Chilean Society of Infectious Diseases on the emergence of serotype 19A pneumococcal infection and the use of pneumococcal conjugated vaccine in Chilean children].

Rev Chilena Infectol 2016 Jun;33(3):304-6

Inclusion of the 10-valent pneumococcal conjugated vaccine (PCV10) in the Chilean infant vaccination Program in 2011 was followed by a reduction of hospital admissions and pneumonia-related deaths in this age group. However, a progressive increase of serotype 19A pneumococcal isolates (not included in PCV10) has been observed. According to the analysis of pneumococcal strains performed by the national reference laboratory of the Institute of Public Health as part of a national surveillance on invasive pneumococcal infections, the relative proportion of serotype 19A isolates increased from <5% before 2010 to 12-23% in years 2014-2015. Serotype 19A represented 4-8% of the isolates in the pre-vaccine era among children less than 2 years, increasing to 25% during 2014. This increase has been documented in two-thirds of the national territory. Aimong children <5 years of age, 25% of 19A serotype isolates from non-meningeal infections were penicillin resistant wheras from meningeal infections near 100% were penicillin resistant. Genetic analysis indicates that 48% of these 19A strains belong to clonal complex 320, recognized for its pandemic potential and high antimicrobial resistance. Among children, most invasive infections secondary to serotype 19A have occurred in patients fully vaccinated with PCV10. These epidemiological changes indicate an increase in invasive pneumococcal infections by serotype 19A in Chile and the need to control this problem by changing the current PCV10 for the PCV13 vaccine containing serotype 19A.
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June 2016