Browsing by Author "Thompson, Luis"
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Item A prospective, multi-center study of Candida bloodstream infections in Chile(2019) Santolaya, Maria E.; Thompson, Luis; Tapia, Cecilia; Legarraga, Paulette; Cortés, Claudia; Rabello, Marcela; Valenzuela, Romina; Rojas, Pamela; Rabagliati, RicardoBackground Active surveillance is necessary for improving the management and outcome of patients with candidemia. The aim of this study was to describe epidemiologic and clinical features of candidemia in children and adults in tertiary level hospitals in Chile. Methods We conducted a prospective, multicenter, laboratory-based survey study of candidemia in 26 tertiary care hospitals in Chile, from January 2013 to October 2017. Results A total of 780 episodes of candidemia were included, with a median incidence of 0.47/1,000 admissions. Demographic, clinical and microbiological information of 384 cases of candidemia, from 18 hospitals (7,416 beds), was included in this report. One hundred and thirty-four episodes (35%) occurred in pediatric patients and 250 (65%) in adult population. Candida albicans (39%), Candida parapsilosis (30%) and Candida glabrata (10%) were the leading species, with a significant difference in the distribution of species between ages. The use of central venous catheter and antibiotics were the most frequent risk factors in all age groups (> 70%). Three hundred and fifteen strains were studied for antifungal susceptibility; 21 strains (6.6%) were resistant to fluconazole, itraconazole, voriconazole, anidulafungin or micafungin. The most commonly used antifungal therapies were fluconazole (39%) and echinocandins (36%). The overall 30-day survival was 74.2%, significantly higher in infants (82%) and children (86%) compared with neonates (72%), adults (71%) and elderly (70%). Conclusions Our prospective, multicenter surveillance study showed a low incidence of candidemia in Chile, with high 30-day survival, a large proportion of elderly patients, C. glabrata as the third most commonly identified strain, a 6.6% resistance to antifungal agents and a frequent use of echinocandins.Item Active surveillance of candidemia in children from Latin America: a key requirement for improving disease outcome.(Lippincott Williams & Wilkins, 2014) Santolaya, María; Alvarado-Matute, Tito; Queiroz-Telles, Flavio; Colombo, Arnaldo; Zurita, Jeanette; Tiraboschi, Iris; Cortes, Jorge; Thompson, Luis; Guzman, Manuel; Sifuentes, José; Echevarria, Juan; Nucci, Marcio; Latin American Invasive Mycosis NetworkBACKGROUND: Active surveillance is necessary for improving the management and outcomes of patients with candidemia. The aim of this study was to describe the epidemiologic and clinical features of candidemia in pediatric patients in Latin America. METHOD: Prospective, multicenter, surveillance study of candidemia in a pediatric population from 23 hospitals in 8 Latin America countries between November 2008 and October 2010. RESULTS: Three hundred and two cases of candidemia were reported with a median incidence of 0.81/1000 admissions. Eighty nine (29%) were neonates. The main risk factors were prematurity, intensive care unit (ICU) admission, parenteral nutrition, respiratory disease and mechanical ventilation in neonates and malignancy, neutropenia, neurological disease and previous use of corticosteroids in children. The main species isolated in neonates and children were Candida albicans (43.8% and 35.7%), Candida parapsilosis (27.0% and 26.3%) and Candida tropicalis (14.6% and 14.6%), respectively. The most frequent antifungal therapy used in neonates and children was deoxycholate-amphotericin-B (43.8% and 29.1%) and fluconazole (28.1% and 53.1%). Seventeen neonates (19.1%) and 20 children (9.4%) did not receive antifungal therapy. The 30-day survival rate was 60% in neonates and 72% in children (P = 0.02). Survival was significantly higher in treated than in nontreated neonates (72% vs. 24%; P < 0.001). A multivariate analysis showed that independent predictors for 30-day mortality in children were renal disease (odds ratio: 4.38, 95% confidence interval: 1.92-10.1, P < 0.001) and receipt of corticosteroids (odds ratio: 2.08, 95% confidence interval: 1.04-4.17, P = 0.04). CONCLUSIONS: To our knowledge, this is the first prospective, multicenter surveillance study of candidemia in children in Latin America. This epidemiologic information may provide us with methods to improve preventive, diagnostic and therapeutic strategies in our continent.Item Bacteriemia en daño hepático crónico(2011) Munita, José; Araos, Rafael; Pérez, Jorge; Alvarez, Alejandra; Canals, Magdalena; Contreras, Jorge; Marcotti, Alejandra; Thompson, Luis; Noriega, LuisBacteremic infections are more frequent in patients with cirrhosis, as their immune system is compromised. Series of cirrhotic patients with bacteremia has seldom been reported in Chile. We retrospectively collected, from 2005 to 2008, 59 episodes of bacteremia in cirrhotics representing 9% of the overall number of bacteremic episodes seen in our center in the period. Spontaneous bacteremia accounted for 29% followed by those of pulmonary origin (22%). Grampositive cocci and gramnegative bacilli were responsible in 52% and 48% respectively, however gramnegative rods predominated in nosocomial bacteremias. Overall, the most frequent organisms were Staphylococcus aureus (24%) and Escherichia coli (22%). Mortality in bacteremic patients was significantly higher compared with all cirrhotic patients hospitalized in the period (37.0 vs 9.4%; p < 0.001) and MELD score was significantly correlated with mortality. Conclusion: bacteremia is a severe complication of cirrhosis and MELD score could be a useful tool to stratify risk in these patients.Item Breakthrough bacteremia due to clostridium tertium in a patient with neutropenic fever, and identification by MALDI-TOF mass spectrometry.(Elsevier, 2013) Salvador, Francisco; Porte, Lorena; Duran, Luisa; Marcotti, Alejandra; Pérez, Jorge; Thompson, Luis; Noriega, Luis; Lois, Vivianne; Weitzel, ThomasClostridium tertium is rare in a human clinical specimen and its pathogenicity is often uncertain. However, the organism has been increasingly recognized as a cause of bacteremia and other infections in immunocompromised patients, especially those with hematologic malignancies. The diagnosis and treatment of C. tertium are difficult due to its growth pattern, micromorphology, and antibiotic resistance. The organism can easily be misidentified as Gram-positive aerobic rods such as Bacillus species, usually considered as a contaminant. Furthermore, it is not covered by empirical treatment with many broad-spectrum antibiotics. Here we report a case of breakthrough bacteremia due to C. tertium that occurred in a patient with acute leukemia and neutropenic fever, who was treated with an empirical regimen of ceftazidime and amikacin. The bacterium was rapidly identified by new mass spectrometry technology (MALDI-TOF MS) and the patient recovered under meropenem and vancomycin treatment, without complications.Item Cryptococcus bacillisporus (VGIII) Meningoencephalitis Acquired in Santa Cruz, Bolivia(2021) Thompson, Luis; Porte, Lorena; Díaz, Violeta; Díaz, María; Solar, Sebastián; Valenzuela, Pablo; Norley, Nicole; Pires, Yumai; Carreño, Fernando; Valenzuela, Sergio; Shabani, Rukmane; Rickerts, Volker; Weitzel, ThomasWe describe a case of chronic meningoencephalitis with hydrocephalus caused by Cryptococcus bacillisporus (VGIII) in an immunocompetent patient from Santa Cruz, Bolivia. This first report of a member of the Cryptococcus gattii species complex from Bolivia suggests that C. bacillisporus (VGIII) is present in this tropical region of the country and complements our epidemiological and clinical knowledge of this group of emerging fungal pathogens in South America.Item Epidemiology of candidemia in Latin America: a laboratory-based survey(PLoS, 2013) Nucci, Marcio; Queiroz-Telles, Flavio; Alvarado-Matute, Tito; Tiraboschi, Iris; Cortes, Jorge; Zurita, Jeannete; Guzman-Blanco, Manuel; Santolaya, Maria; Thompson, Luis; Sifuentes-Osornio, Jose; Echevarria, Juan; Colombo, ArnaldoBACKGROUND: The epidemiology of candidemia varies depending on the geographic region. Little is known about the epidemiology of candidemia in Latin America. METHODS: We conducted a 24-month laboratory-based survey of candidemia in 20 centers of seven Latin American countries. Incidence rates were calculated and the epidemiology of candidemia was characterized. RESULTS: Among 672 episodes of candidemia, 297 (44.2%) occurred in children (23.7% younger than 1 year), 36.2% in adults between 19 and 60 years old and 19.6% in elderly patients. The overall incidence was 1.18 cases per 1,000 admissions, and varied across countries, with the highest incidence in Colombia and the lowest in Chile. Candida albicans (37.6%), C. parapsilosis (26.5%) and C. tropicalis (17.6%) were the leading agents, with great variability in species distribution in the different countries. Most isolates were highly susceptible to fluconazole, voriconazole, amphotericin B and anidulafungin. Fluconazole was the most frequent agent used as primary treatment (65.8%), and the overall 30-day survival was 59.3%. CONCLUSIONS: This first large epidemiologic study of candidemia in Latin America showed a high incidence of candidemia, high percentage of children, typical species distribution, with C. albicans, C. parapsilosis and C. tropicalis accounting for the majority of episodes, and low resistance rates.Item Falla de tratamiento en neumonía adquirida en la comunidad: coccidioidomicosis en un viajero(Sociedad Chilena de Infectología, 2013) Cabello, Hernán; Labarca, Gonzalo; Fernández-Bussy, Sebastián; Cabello, Francisca; Pires, Yumay; Soto, Rodrigo; Thompson, LuisLa neumonía de evolución tórpida son aquellas en que no se logra una respuesta clínica adecuada con el uso de terapia antimicrobiana. Existen múltiples causas a esta falta de respuesta: resistencia antimicrobiana, microorganismos no cubiertos o infecciones por microorganismos atípicos. Coccidioides immitis es un hongo causante de neumonía en el hemisferio norte, especialmente en E.U.A y norte de México. No existen reportes de casos pulmonares importados en Chile. Presentamos el caso de una mujer adulta con una neumonía que no respondió al tratamiento antimicrobiano habitual. Una vez realizado un estudio exhaustivo, se logró establecer mediante el estudio histopatológico la existencia de una coccidiodomicosis como entidad causal, logrando una respuesta clínica y radiológica favorable al tratamiento antifúngico.Item Imported scrub typhus: first case in South America and review of the literature(2018) Weitzel, Thomas; Aylwin, Mabel; Martínez-Valdebenito, Constanza; Jiang, Ju; Munita, José; Thompson, Luis; Abarca, Katia; Richards, Allen L.Background Scrub typhus is a neglected vector-borne zoonosis causing life-threatening illnesses, endemic in the Asian-Pacific region and, as recently discovered, in southern Chile. Scrub typhus is rarely reported in travelers, most probably due to the lack of clinical experience and diagnostic tests in non-endemic countries. We report the first case of imported scrub typhus in South America. Case presentation A 62-year-old tourist from South Korea presented severely ill with fever, rash, and eschar in Santiago, Chile. Laboratory exams showed thrombocytopenia and elevated inflammation parameters, hepatic enzymes, and LDH. With the clinical suspicion of scrub typhus, empirical treatment with doxycycline was initiated and the patient recovered rapidly and without complications. The diagnosis was confirmed by IgM serology and by real-time PCR, which demonstrated infection with Orientia tsutsugamushi (Kawasaki clade). Conclusions Only due to the emerging clinical experience with endemic South American scrub typhus and the recent implementation of appropriate diagnostic techniques in Chile, were we able to firstly identify and adequately manage a severe case of imported scrub typhus in South America. Physicians attending febrile travelers need to be aware of this rickettsiosis, since it requires prompt treatment with doxycycline to avoid complications.Item Infección por Bartonella henselae: utilidad de las imágenes en el diagnóstico y seguimiento.(Sociedad Chilena de Infectología, 2017) Tapia, Fernanda; Rosas, Reinaldo; Schiappacasse, Giancarlo; Thompson, LuisBartonella henselae infection is a frequent zoonosis from the domestic cat. It is presented with regional lymphadenitis in the majority of cases. Searching and characterization of lymph nodes by diagnostic imaging can be useful in the differential diagnosis approach, with a clear advantage, because it is a noninvasive method. Currently, new diagnostic imaging techniques improves the quality of screening and characterization of adenopathies, such is the case of PET/CT, which allows a better evaluation of hypermetabolic lymph nodes, without considering the individual growth of each lymph node. In this article, three cases of cat scratch diseases serology and their respective imaging findings are reviewed.Item Infecciones respiratorias bacteriémicas por Neisseria meningitidis serogrupo W(Sociedad Chilena de Infectología, 2015) Rosas, Reinaldo; Solar, Sebastián; Durán, Luisa; Noriega, Luis; Thompson, Luis; Marcotti, Alejandra; Pérez, Jorge; Weitzel, ThomasN. meningitidis serogroup W has recently been introduced into Chile. This serogroup has been associated with hypervirulent strains capable of causing outbreaks. Furthermore, there is data suggesting that the spectrum of clinical manifestations varies among different serogroups. Here we describe three cases of community acquired respiratory infections caused by N. meningitidis W, which were diagnosed by blood culture during 2013 in our hospital.Item Laboratory exposure to Coccidioides: lessons learnt in a non-endemic country(Elsevier Ltd, 2019-08) Porte, Lorena; Valdivieso, Francisca; Wilmes, Dunja; Thompson, Luis; Munita, José; Varela, Carmen; Rickerts, Volker; Weitzel, Thomas; Gaete, P; Díaz, MC; Alliende, RCoccidioides is a primary pathogenic fungus, which infects humans through highly infectious arthroconidia, causing substantial morbidity including life-threatening disseminated infections. Due to the low infectious dose, laboratory personnel might become infected during diagnostic procedures. Accordingly, coccidioidomycosis is reported as the most frequent laboratory-acquired systemic mycosis worldwide. This risk is aggravated in non-endemic countries, where the diagnosis may not be suspected. We report on an inadvertent exposure of 44 persons to Coccidioides posadasii in a clinical microbiology laboratory in Chile, the measures of containment after rapid diagnosis with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and the lessons learnt in a non-endemic setting.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 Polirradiculoneuritis aguda asociada a infección por Virus Herpes Humano 7 en un paciente adulto inmunocompetente(2017) Jara, Paula; Verdugo, Renato; Thompson, LuisEl Virus Herpes Humano 7 (VHH-7), es un virus DNA de doble cadena, neurotrópico y linfotrópico, que pertenece a la subfamilia de los herpes virus. Está presente en 96 a 100% de la población adulta, el 70% de los casos se infectan durante los primeros 5 años de vida y el 30% restante más tardíamente. Es transmitido por vía oral y posterior a la infección primaria se mantiene latente en los linfocitos T CD4+ y en las células epiteliales de las glándulas salivales. La primoinfección durante la niñez se ha asociado principalmente con cuadros de exantema súbito, pitiriasis rosada y crisis febriles1,2. En la población adulta tanto la primoinfección como la reactivación del virus se ha asociado a compromiso neurológico, desde encefalitis y meningitis a cuadros de mielitis, estos últimos casos pueden asociarse o no a polirradiculitis y compromiso de pares craneanos3–5. Estas manifestaciones neurológicas se han presentado en pacientes inmunocompetentes e inmunodeprimidos, correspondiendo algunos de ellos a reactivación de la infección previamente adquirida y en otros a infección primaria en la adultez1,2. Comunicamos el caso clínico de un paciente adulto inmunocompetente que presentó una polirradiculitis aguda asociada a (VHH-7), sin mielitis ni otro compromiso del Sistema Nervioso Central (SNC).Publication Prevalence of chronic pulmonary aspergillosis regarding time of tuberculosis diagnosis in Brazil(2022) Volpe-Chaves, Cláudia E.; Venturini, James; Castilho, Suse B.; Fonseca, Simone S. O.; Nunes, Thiago F.; Cunha, Eunice A. T.; Lima, Gláucia M. E.; Nunes, Maína O.; Vicentini, Adriana P.; Oliveira, Sandra M. V. L.; Carvalho, Lídia R.; Thompson, Luis; Mendes, Rinaldo P.; Paniago, Anamaria M. M.Background: Data on the prevalence of chronic pulmonary aspergillosis (CPA) in patients with active or cured tuberculosis (TB) are scarce, mainly due to diagnostic difficulties. The diagnosis of CPA is based on pulmonary symptoms and chest computed tomography (CT) scans and is considered confirmed when there is microbiological or serological evidence of Aspergillus spp. Objectives: To estimate the prevalence of CPA in patients treated or undergoing treatment for PTB, seen in two referral hospitals in Mato Grosso do Sul, Brazil. Patients and methods: A total of 193 consecutive patients who were treated or previously treated for pulmonary tuberculosis underwent prospective evaluation: (a) clinical evaluation; (b) chest CT scan; (c) sputum examination-culture for fungi and smears for direct mycology; (d) detection of anti-Aspergillus fumigatus antibodies using an enzyme-linked immunosorbent assay Platelia® test; and (e) anti-Aspergillus spp. antibodies were assessed via a DID test. Results: The global prevalence of CPA was 10.9% (95% confidence interval, 7.2%-16.1%), but it increased with the time of TB diagnosis. The variables independently associated with CPA were previous pulmonary tuberculosis over 4 years ago and haemoptysis. Cavities, pleural thickening and the presence of a fungal ball were the most frequent tomographic findings in patients with CPA. Conclusions: The high prevalence observed and its increase over time suggest the need for continuous surveillance of CPA in patients with active or previous pulmonary tuberculosis and throughout life, with clinical, tomographic and serological evaluations (ELISA) for a timely diagnosis and a better prognosis.Item Vulvitis migratoria causada por gnatostomiasis importada(2019) Rosas, Reinaldo; Marcotti, Alejandra; Weitzel, Thomas; Thompson, LuisGnathostomiasis is an emerging disease in non-endemic countries. This zoonotic nematode requires aquatic freshwater environments to complete its life cycle where larvae get encrusted in fishes. Typically, the infection manifests as migratory subcutaneous lesion caused by the larvae trak, which produces an eosinophilic panniculitis. Here we describe a patient who presented a migratory lesion with no response to antimicrobial therapy, a careful travel and food history together with specific laboratory tests led to the correct diagnosis. Gnathostomiasis should be suspected in patients with migratory skin lesions who have consumed raw freshwater fish during travel to endemic countries in South America or A