Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

This is a case report of an american woman who consulted in our country for multiple erythema migrans, from which a Lyme disease was diagnosed. This infectious disease is caused by spirochetes from the Borrelia burgdorferi sensu lato complex (Bbsl) and is transmitted by the bite of ticks. Traditionally Bbsl had been detected in ticks only in the Northern Hemisphere. However, since 2013 there have been reports in South America. In Chile, Borrelia chilensis was recently described, which does not have an associated disease in humans. Aspects of the infectious agent, its epidemiology, its vectors and new findings in South America are discussed. Likewise, the clinical diagnostic criteria, laboratory and appropriate treatment are proposed, according to the stage in their natural history.

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.

El Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA (ONUSIDA) promueve el desarrollo de estimaciones poblacionales relacionadas a esta epidemia, a partir del uso del software SPECTRUM. En Chile las estimaciones se actualizan anualmente, correspondiendo la última de ellas al año 2017, proceso que contó con la participación de representantes del Ministerio de Salud con la asesoría de expertos de la sede de ONUSIDA en Ginebra. El desarrollo del proceso de estimaciones 2017 arrojó un número de 67.000 personas con infección por VIH en el año 2017 (límite inferior de 58.000 - límite superior de 76.000), con una prevalencia en el grupo de 15 a 49 años de 0,6% (0,5-0,6%) y una incidencia de 0,33 por mil habitantes. El presente documento sintetiza el proceso de estimaciones 2017 realizado en Chile, así como los principales resultados generados a través de esta metodología.

Escherichia vulneris is a gram-negative bacillus that belongs to the family Enterobacteriaceae, with a questioned pathogenic role. However, it has been confirmed as the cause of wound infections. We report the case of a 12-year-old girl, previously healthy, with a diagnosis of septic arthritis of the right knee, secondary to a spinal lesion. Escherichia vulneris, an unusual etiology of septic arthritis in children, was isolated in the joint fluid. This case is one of the first cases of septic arthritis due to E. vulneris, secondary to a plant-derived foreign body in a child, described in the medical literature. The importance of performing the microbiological study of joint fluid in patients with septic arthritis caused by a foreign body of plant-derived origin is emphasized.

Background: Microorganisms isolated from blood cultures (BC) in patients with febrile neutropenia (NF) vary over time, requiring systematic monitoring to guide appropriate empirical therapy. Aim: To identify microorganisms isolated from BC and their antimicrobial resistance profile in children with cancer and high risk NF. Method: Prospective, multicenter study. The analysis included episodes of high-risk FN with positive BC in children under 18 years of age treated in five hospitals in Santiago, Chile, 2012-2015. Results: A total of 206 microorganisms were analyzed in 185 episodes of high-risk FN. The main isolates were Gram negative bacilli (46.6%) and Gram positive cocci (45.1%) and the most frequent microorganisms were Escherichia coli (22.8%), coagulase negative Staphylococcus (18.0%) and Klebsiella spp. (16.5%). Escherichia coli and Klebsiella spp showed 4.2% and 67.6% resistance to third generation cephalosporins (cefotaxime/ceftriaxone), 10.6% and 40.6% resistance to fluoroquinolones (ciprofloxacin) and 2.1% and 26.5% to amikacin, respectively. Coagulase negative Staphylococcus and Staphylococcus aureus had 86.4% and 22.2% resistance to oxacillin, Streptococcus viridans group had 71% resistance to penicillin. Discussion: This study updates the etiology and resistance profile of microorganisms isolated in BC from children with cancer and high risk FN, an essential tool for the adequate management of these patients.

Background: Enterobacteria resistant to quinolones is increasing worldwide, including Venezuela. The mechanism for this resistance could be due to genes included in the chromosome or in transmissible plasmids. Aim: To evaluate the resistance to quinolones, coded by qnr genes present in enterobacteria species, isolated in the University Hospital of Cumana, Venezuela. Methods: Antimicrobial susceptibility tests to quinolones, beta-lactams and aminoglycosides were carried out to all the isolates. The presence of qnr genes were determined by PCR. The isolates carrying the qnr genes were used for bacterial conjugation tests to determine the presence of transferable plasmids. Antimicrobial susceptibility tests and PCR were carried out in the transconjugants to verify the transfer of the genes. Results: High levels of antimicrobial resistance to quinolones and beta-lactams were found among the isolates. We found that 33.6% of the isolates carry the qnrB gene and 0.9% qnrA gene. Of the 23 transconjugants, 20 showed to have qnrB gene, but none qnrA. Discussion: We concluded that the high frequency of qnr genes found in the enterobacteria isolates and their presence on transferable plasmids, complicate the use of quinolones for the treatment of bacterial infections, thus, a treatment plan should be designed with the rational use and the rotation of different types of antimicrobials, in order to avoid the selection of increasingly resistant strains.

Background: Histoplasmosis is a mycosis with a high prevalence in HIV/AIDS patients. Clinical presentation includes a wide spectrum of manifestations and diagnosis usually takes up to several weeks in patients who do not present cutaneous lesions. Aim: To determine the clinical and microbiological characteristics as well as some biochemical parameters in patients with AIDS-associated histoplasmosis without tegumentary lesions, in order to develop a guideline which enables an early empiric treatment in cases of difficult diagnosis. Methods: Medical records of 86 patients with histoplasmosis were reviewed; 31 patients with diagnosis of AIDS-associated histoplasmosis without cutaneous lesions were analyzed. Results: Fever was the most frequent symptom (96.7%), lung involvement was observed in 22 patients (70.9%), the most commonly radiological pattern was miliary pattern [(12/22), 54.5%]. Nineteen patients presented with splenomegaly. Blood culture sensitivity was 93.3% (28/30) and serology was positive only in 23.5% of the cases. Eight patients died (25.8%). Patients in which CD4+ T cell lymphocytes count was < 50 cells/μl, albumin levels < 2.5 g/dl and who presented with pancytopenia had an unfavorable outcome. Conclusions: In HIV seropositive patients with fever associated to splenomegaly and bilateral miliar pattern in chest radiography, the empiric treatment with amphotericin B must be considered if signs and symptoms of unfavorable outcome are present and due to the time that it takes to arrive at an accurate diagnosis. In order to confirm the diagnosis, all microbiological samples should be collected prior to initiating therapy.

Introduction: Dental care has become a challenge for healthcare associated infection prevention programs, since the environment, within other factors, plays an important role in the transmission chain. Materials and Methods: An intervention program was designed for the Dental Unit of Hospital Militar de Santiago, between years 2014 and 2015. The program contemplated 3 stages: diagnostic, intervention and evaluation stage. Objective: To improve the safety of critical surfaces involved in dental healthcare. Results: During the diagnostic stage, the cleaning and disinfection process was found to be deficient. The most contaminated critical surface was the instrument holder unit, then the clean area and lamp handle. The surfaces that significantly reduced their contamination, after the intervention, were the clean area and the instrument carrier unit. Conclusion: Training in the processes of cleaning and disinfecting surfaces and dental equipment is one of the cost-effective strategies in preventing healthcare-associated infections (HCAI), with simple and easy-to-apply methods.

Background: Dengue and chikungunya viruses are transmitted by the female Aedes aegypti and Aedes albopictus, which are widely distributed in tropical and subtropical areas, facilitating coinfection. Aim: To determine the magnitude, geographical distribution and clinical picture of dengue and chikungunya coinfection. Material and Methods: Narrative review. A search in the PubMed and Lilacs databases was made, using the MeSH terms “Chikungunya”, “CHIKV”, “DENV”, “Dengue” and “coinfection. The articles of the last 20 years were included. Results: A total of 45 articles were included. The largest coinfection report was in Asia followed by Africa. In the Americas, the information is limited because of the recent circulation of chikungunya. The magnitude of coinfection varies between 0% and 31.9%. No differences were found in the distribution of coinfection by sex and age. The clinical picture of monoinfection and coinfection was similar. Some case reports show severe cases with central nervous system involvement, hemorrhagic manifestations and Still’s disease. Conclusion: The clinical manifestations of coinfection by dengue and chikungunya viruses are similar to those due to monoinfection, which difficult the diagnosis and measurement of its magnitude.