RESUMEN
OBJECTIVE: To describe a severe case of infection by Leptospira in a woman in the northwest of Mexico. CASE REPORT: A 55-yearold woman from Sonora, México arrived at the Intensive Care Unit due to severe multiple organ failure primarily affecting the respiratory, renal and hepatic systems. Diagnostic tests were performed, and they were positive for anti-Leptospira antibodies, IgM and IgG; and spirochetes were observed on dark field microscopy and confirmed by Polymerase Chain Reaction (PCR). Doxycycline and platelet apheresis transfusion were used as treatment, which led to a very slow recovery. CONCLUSION: The information presented in this study may help in the identification of pathology caused by spirochetes. This case report is the first to present a case of severe leptospirosis in Sonora, México.
Asunto(s)
Leptospira , Leptospirosis , Insuficiencia Multiorgánica/microbiología , Antibacterianos/uso terapéutico , Anticuerpos Antibacterianos/sangre , Doxiciclina/uso terapéutico , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Unidades de Cuidados Intensivos , Leptospira/genética , Leptospira/crecimiento & desarrollo , Leptospirosis/complicaciones , Leptospirosis/diagnóstico , Leptospirosis/microbiología , Leptospirosis/terapia , México , Microscopía/métodos , Persona de Mediana Edad , Insuficiencia Multiorgánica/diagnóstico , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/terapia , Transfusión de Plaquetas , Reacción en Cadena de la Polimerasa , Índice de Severidad de la EnfermedadRESUMEN
INTRODUCTION: Invasive mycosis of the central nervous system represent a diverse group of diseases that have gradually emerged as not only opportunistic infections in patients with immune susceptibility due to congenital and acquired deficiency, immunomodulation, solid organ and stem cell transplantation, hematological malignancies, and chronic steroid use but also in selected risk populations such as low weight preterm infants, patients with shunted hydrocephalus and external ventricular drainages, skull base surgery, and head injury. OBJECTIVES: The purpose of this review is to familiarize the pediatric neurosurgeon with the most common mycosis and their clinical scenarios which can be encountered in the clinical practice, with special emphasis on clinical, radiological, and laboratory diagnosis beyond classical microorganism cultures as well as options in medical and surgical treatment given the high incidence of morbidity and mortality associated with these challenging entities. METHODS: We conducted an online database review (Ovid, PubMed) gathering relevant English language literature published in the last 20 years with special emphasis on recent breakthroughs in the diagnosis and treatment of invasive mycosis of the CNS as well as reported cases within the pediatric neurosurgical literature and their surgical management. RESULTS: Fungal agents capable of invading the CNS can behave as aggressive entities with rapid progression manifesting as overwhelming meningoencephalitis with vascular compromise or can lead to space-occupying lesions with abscess formation which require prompt diagnosis by either laboratory identification of the components of these biological agents and their host response or by obtaining tissue specimens for microbiological identification which may not be straightforward due to prolonged culture time. CONCLUSION: Following a high degree of suspicion with prompt initiation of antifungal agents and reversal of potential immunosuppressant therapies along with neurosurgical evacuation of intracranial collections or removal of infected hardware (CSF shunts) can lead to more optimistic outcomes of these complex clinical scenarios.
Asunto(s)
Infecciones Fúngicas del Sistema Nervioso Central/diagnóstico , Infecciones Fúngicas del Sistema Nervioso Central/microbiología , Infecciones Fúngicas del Sistema Nervioso Central/cirugía , Niño , Humanos , NeurocirugiaRESUMEN
Se caracterizó la población de trabajadores de salud en el Hospital Nacional de Niños, "Dr. Carlos Sáenz Herrera", San José, Costa Rica, en cuanto al riesgo de adquirir la infección por el virus de la varicela. La seropositividad contra el virus varicela zoster fue del 90,5 por ciento y del 9,5 por ciento para los trabajadores con histoira de contacto positiva y negativa, respectivamente. El valor predictivo positivo de la historia autoreferidad de varicela, demostró ser confiable, identificar a los individuos seropositivos. Debido a que el valor predictivo negativo no es confiable (el 88,6 por ciento de los empleados con una historia negativa o incierta, resultó inmune), se discute que la implementación de una prueba serológica rápida podría resultar costo-beneficiosa para aquellos empleados en esta condición