Browsing by Author "Fica, Alberto"
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Item Brotes de salmonelosis y el tamaño y rol del Estado en Chile(Sociedad Chilena de Infectología, 2012) Fica, Alberto; Acosta-Jamett, Gerardo; Dabanch, Jeannette; Perret, Cecilia; Torres, Marisa; Lopez, Javier; Jofre, Leonor; Weitzel, Thomas; Comité de Infecciones Emergentes de la Sociedad Chilena de InfectologíaDuring year 2011 two outbreaks of Salmonella infection captured media attention in the Metropolitan Area (MA) in Chile: one of typhoid fever associated to Salmonella serotype Typhi, and the other, of gastroenteritis related to Salmonella serotype Enteritidis, both with decreasing or stable rates in the previous years. The aim of this work is to analyze probable causes of their reemergence. Methods: Several government websites were searched looking for epidemiological data. Results: Typhoid fever rates have declined to current values of 1 case per 100.000 habitants, a decreased associated to improvements in the human development index. The typhoid outbreak was associated to a predominant clone within the MA. The only risk factor identified was consumption of raw vegetables acquired in open fairs, but without identifying a common source. Despite improvements in disease notification and molecular epidemiology capabilities, this outbreak is coincidental with a reduced number of food inspection visits in the MA, probably explained by the limited personnel available for this task. In the case of Salmonella Enteritidis, rates have increased twice since 1998 (5.3 to 10.7 per 100.000 habitants) with an important increase in the number of outbreaks linked to this agent (7 to 31 annual outbreaks) since year 2005. Persistence of this problem is probably associated to the low surveillance of poultry farms made by the Chilean state, to the absence of a cold chain during collection, distribution and selling of eggs, and to the lack of an educational program directed to the population. The recent regulation that bans home-made mayonnaise in restaurant or fast food stores is an important advance that requires further evaluation. Conclusions: The persistence and reemergence of different kind of Salmonellosis in Chile suggests chronic problems on the size and role of the Chilean state regarding food safety.Item Cepas chilenas de origen clínico de Vibrio cholerae no-O1, no-O139 portan los genes vcsN2, vcsC2, vcsV2, vspD, toxR2 y vopF del sistema de secreción T3SS2 presentes en una isla de patogenicidad(2019) Ulloa, María Teresa; Sanhueza, Camila; Henríquez, Tania; Aguayo, Benjamín; Hermosilla, Germán; Porte, Lorena; Dabanch, Jeannette; Braun, Stephanie; Fica, Alberto; Briceño, Isabel; Osorio, CarlosBackgound: 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.Item El deterioro de la tuberculosis en Chile(2019) Fica, Alberto; Herrera, Tania; Aguilera, XimenaBackground: 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.Item Gastos hospitalarios en pacientes con fascioliasis en fase aguda, hidatidosis de tratamiento quirúrgico y neurocisticercosis en un hospital general en Chile(Sociedad Chilena de Infectología, 2014) Weitzel, Thomas; Fica, AlbertoBACKGROUND: Acute fascioliasis (FA), cystic echinococcosis (CE) and neurocysticercosis (NCC) are three endemic parasitic diseases in Chile for whom there is scarce information about the economic impact they represent during management at the hospital. AIMS: To quantify and compare hospital care expenses caused by these three endemic helminth infections in a Chilean hospital. METHODS: Retrospective analysis of hospital costs at a referral hospital in Santiago between 2006 and 2010. Hospital databases were used to identify patients with the corresponding infections, and those with sufficient data on hospital costs were included. RESULTS: A total of 16 patients representing 21 cases were identified and analyzed: four with AF, eleven with CE, and six with NCC. Median hospital expenses for cases with AF were US$ 1799 and mainly caused by bed-day costs. Median hospital costs for cases of CE were US$ 4707 and the most important costs components were medications, bed-day costs and consumables. NCC patients had median costs of US$ 1293, which were mainly due to bed-day costs. Non-parenchymatous or mixed forms of NCC showed a trend toward higher hospital costs compared with parenchymatous forms. CONCLUSIONS: Although helminth infections in Chile, an upper middle income country, are declining and considered rare in routine clinical practice, hospital care expenses caused by patients with AF, CE, and NCC are high and might still present an important economic burden to the Chilean healthcare system.Item Is there a risk of filarial infection during long-term missions in Haiti?(Elsevier, 2016) Weitzel, Thomas; Rosas, Reinaldo; Fica, Alberto; Dabanch, Jeannette; Polanco, Myriam; Egaña, Alicia; Triantafilo, Vjera; Pfarr, Kenneth; Hoerauf, Achim; Reiter-Owona, IngridBACKGROUND: Haiti has the highest prevalence of lymphatic filariasis (Wuchereria bancrofti) in the Western Hemisphere. Still, the risk of filarial infection for long-term visitors such as humanitarian aid workers or military personnel is uncertain. The presented study analyzed the exposure to W. bancrofti in Chilean participants of the UN Stabilization Mission in Haiti (MINUSTAH) in 2011. METHODS: Blood samples collected from 531 participants were screened for antifilarial antibodies by IgG ELISA, and, if positive, analyzed by immunofluorescence assay (IFA), IgG4 ELISA, Real-Time PCR, and circulating filarial antigen (CFA) card test. RESULTS: ELISA screening was positive in 10 cases. Seroconversion occurred in only two cases (0.38%) based on ELISA values determined in samples taken before and after deployment. Positive IgG ELISA values could not be confirmed by IFA and IgG4 ELISA. Real-Time PCR and CFA testing did not reveal the presence of filaria. CONCLUSIONS: Our data indicate that in the examined cohort of MINUSTAH participants in 2011, the risk of filarial exposure or infection was low.Item Micobacterias atípicas en cinco pacientes adultos sin evidencias de inmunosupresión. Construyendo una experiencia(Sociedad Chilena de Infectología, 2015) Fica, Alberto; Soto, Andrés; Dabanch, Jeannette; Porte, Lorena; Thompson, Luis; Balcells, ElviraWe aim to communicate the experience gathered during the management of infections by atypical mycobacteria in immunocompetent patients in a general practice. Between 2008 and 2013, 5 patients with non-tuberculous mycobacterial infections were identified: 2 with cutaneous involvement and 3 with lung infection. None of them had evidence of immunosuppression. A patient with elbow bursitis by M. chelonae presented with a high mononuclear count in fluid analysis with mycobacterial growth at the fifth day of culture. He evolved satisfactorily with clarithromycin. A case with M. fortuitum skin infection had a delayed initial diagnosis with progression to local draining lymph nodes; the culture when requested was positive after 13 days of incubation. Patients with pulmonary infection presented with prolonged cough and sputum and had in common to be postmenopausal women displaying small nodules and bronchiectases at lung images, a classical pattern. Time elapsed between respiratory sampling and a definitive inform ranged from 40 to 89 days. Non-tuberculous mycobacterial infections in non-immunosuppresed patients can generate diagnostic and therapeutic challenges. Delay in identification contributes to this problem.Item Quince años de experiencia clínica con hidatidosis(Sociedad Chilena de Infectología, 2012) Fica, Alberto; Soto, Andres; Slater, Jeannie; Peralta, Marcial; Humeres, Roberto; Castro, Marcelo; Gonzalez, Jaime; Weitzel, ThomasIntroduction: Hydatidosis is a neglected parasitic disease that is endemic in Chile. We present the clinical experience of a single center in Santiago from 1996 to 2010. Methods: Cases were identified using hospital's database. Clinical and pathological features, treatment and outcomes were retrospectively analyzed. Results: In total, 23 patients were identified requiring 30 surgical interventions. Median age was 40 years old (range 5 to 73), and 76.5% visited or resided in regions of known endemicity in Chile. Abdominal cysts were predominant (78.3%), and most patients were symptomatic (73.9%). Elimination of cyst material by cough was reported in 42.9% of patients with symptomatic thoracic cysts. Eosinophilia was present in 41.2% of patients, and 57.1% had positive serology for hydatidosis. Aill patients underwent surgical treatment, in 60.9% in combination with albendazole treatment. While the majority of liver cysts (88.9%) were treated by complete cyst resection, lung cysts (83.3%) were predominantly treated by cyst resection plus capitonnage. Pathological examination revealed fertile cysts in 24%. Postsurgical morbidity was frequent (37.9%), and 13.3% of the series required readmission for this cause. Near 25% of patients remained in hospital > 14 days, a feature associated with fever during admission (p < 0.05). No recurrence was reported in the fraction of patients that were followed-up for 2 years or more. Conclusions: Our analysis of 23 cases demonstrates that patients were mainly adults suffering from abdominal cysts. Most patients were successfully treated by surgery with or without antiparasitic drugs but complications leading to prolonged hospital stays and readmissions were not infrequent.