RESUMEN
BACKGROUND: In a decade, we faced two pandemic viruses, influenza A H1N1pdm09 and SARS CoV-2, whose most serious manifestation is pneumonia. AIM: To compare the clinical, epidemiological and management aspects of pneumonias caused by each pandemic virus in adults requiring hospitalization. MATERIAL AND METHODS: Comparative, observational study carried out at a regional Chilean hospital, including 75 patients with influenza A H1N1pdm09 prospectively studied in 2009 and 142 patients with SARS-CoV-2 studied in 2020. RESULTS: Patients with SARS-CoV-2 pneumonia were older (56 and 39.7 years respectively, p < 0.01) and had significantly more comorbidities. Cough, fever and myalgias were more frequent in influenza. Dyspnea was more frequent in COVID-19. Patients with COVID-19 had more extensive lung involvement and a longer hospitalization (13.6 and 8.6 days respectively, p = 0.01). There was no difference on ICU admission requirements and mortality attributable to pneumonia. Patients with influenza had greater APACHE scores and a higher frequency of a PaO2/FiO2 ratio ≤ 200. During COVID-19pandemic chest sean replaced x-ray examination. Also high-flow nasal cannulas and awake prone position ventilation were added as treatments. CONCLUSIONS: COVID-19 patients were older, had fewer classic flu symptoms but more dyspnea and longer hospitalization periods than patients with influenza.
Asunto(s)
COVID-19 , Gripe Humana , Neumonía Viral , Adulto , COVID-19/epidemiología , Disnea , Hospitalización , Humanos , Gripe Humana/diagnóstico , Gripe Humana/epidemiología , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/terapia , SARS-CoV-2RESUMEN
BACKGROUND: In a decade, we faced two pandemic viruses, influenza A H1N1pdm09 and SARS CoV-2, whose most serious manifestation is pneumonia. AIM: To compare the clinical, epidemiological and management aspects of pneumonias caused by each pandemic virus in adults requiring hospitalization. Material and Methods: Comparative, observational study carried out at a regional Chilean hospital, including 75 patients with influenza A H1N1pdm09 prospectively studied in 2009 and 142 patients with SARS-CoV-2 studied in 2020. RESULTS: Patients with SARS-CoV-2 pneumonia were older (56 and 39.7 years respectively, p < 0.01) and had significantly more comorbidities. Cough, fever and myalgias were more frequent in influenza. Dyspnea was more frequent in COVID-19. Patients with COVID-19 had more extensive lung involvement and a longer hospitalization (13.6 and 8.6 days respectively, p = 0.01). There was no difference on ICU admission requirements and mortality attributable to pneumonia. Patients with influenza had greater APACHE scores and a higher frequency of a PaO2/FiO2 ratio ≤ 200. During COVID-19pandemic chest sean replaced x-ray examination. Also high-flow nasal cannulas and awake prone position ventilation were added as treatments. Conclusions: COVID-19 patients were older, had fewer classic flu symptoms but more dyspnea and longer hospitalization periods than patients with influenza.
Asunto(s)
Humanos , Adulto , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Neumonía Viral/epidemiología , Gripe Humana/diagnóstico , Gripe Humana/epidemiología , COVID-19/epidemiología , Disnea , Pandemias , SARS-CoV-2 , HospitalizaciónRESUMEN
BACKGROUND: Hantavirus cardiopulmonary syndrome (HCPS) is caused by new world hantaviruses, among which Andes hantavirus (ANDV) is endemic to Chile and Southern Argentina. The disease caused by ANDV produces plasma leakage leading to enhanced vascular permeability and has a high case fatality rate (35%), mainly due to respiratory failure, pulmonary edema and myocardial dysfunction, hypoperfusion and shock. Host sociodemographic and genetic factors might influence the course and outcome of the disease. Yet, they have not been thoroughly characterized. AIM: To evaluate sociodemographic factors as risk factors in severity of HCPS. PATIENTS AND METHODS: Study period: 2004-20013, attending in eight collaborative centers, etiological diagnosis was performed by serology or molecular biology, mild and severe HCPS were compared.139 Chilean patients were analyzed, 64 (46%) with severe disease among which 12 (19 %) died. RESULTS: European ethnicity had 5,1 times higher risk than Amerindian ethnic group to develop a severe HCPS, greater seriousness that was also associated with an urban residence. CONCLUSION: It was observed that ethnicity and type of residence were significant risk factors for HCPS severity. Hypotheses explaining these findings are discussed.
Asunto(s)
Síndrome Pulmonar por Hantavirus/mortalidad , Adolescente , Adulto , Anciano , Niño , Chile/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Adulto JovenRESUMEN
Resumen Introducción: El síndrome cardiopulmonar por hantavirus (SCPH) es causado en Chile y en el sur de Argentina por el Andes hantavirus (ANDV), el que es endémico en esta zona. La enfermedad causada por ANDV produce un aumento de permeabilidad vascular y filtración de plasma con una alta tasa de letalidad (35%), debido principalmente a insuficiencia respiratoria por edema pulmonar y al desarrollo en los casos graves de compromiso miocárdico, hipoperfusión y shock. Aunque se sabe que los factores socio-demográficos del hospedero pueden influir en el curso y el resultado de la enfermedad, estos no se han caracterizado previamente en la población chilena. Objetivo: Evaluar la relación entre los factores socio-demográficos y la gravedad del SCPH. Pacientes y Métodos: Período de análisis 2004-20013, pacientes atendidos en ocho centros colaboradores, diagnóstico etiológico serológico o por biología molecular, se comparan SCPH leve y grave. Se analizaron 139 pacientes chilenos, 64 (46%) con enfermedad grave, entre los cuales 12 murieron (19%). Resultados: La etnia europea tuvo un riesgo 5,1 veces mayor de desarrollar un SCPH grave que la etnia amerindia, gravedad mayor que también se asoció a una residencia urbana. Conclusiones: Se observó una asociación estadísticamente significativa entre etnia, lugar de residencia y evolución de SCPH. Se discuten hipótesis que expliquen estos hallazgos.
Background: Hantavirus cardiopulmonary syndrome (HCPS) is caused by new world hantaviruses, among which Andes hantavirus (ANDV) is endemic to Chile and Southern Argentina. The disease caused by ANDV produces plasma leakage leading to enhanced vascular permeability and has a high case fatality rate (35%), mainly due to respiratory failure, pulmonary edema and myocardial dysfunction, hypoperfusion and shock. Host sociodemographic and genetic factors might influence the course and outcome of the disease. Yet, they have not been thoroughly characterized. Aim: To evaluate sociodemographic factors as risk factors in severity of HCPS. Patients and Methods: Study period: 2004-20013, attending in eight collaborative centers, etiological diagnosis was performed by serology or molecular biology, mild and severe HCPS were compared.139 Chilean patients were analyzed, 64 (46%) with severe disease among which 12 (19 %) died. Results: European ethnicity had 5,1 times higher risk than Amerindian ethnic group to develop a severe HCPS, greater seriousness that was also associated with an urban residence. Conclusion: It was observed that ethnicity and type of residence were significant risk factors for HCPS severity. Hypotheses explaining these findings are discussed.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Síndrome Pulmonar por Hantavirus/mortalidad , Factores Socioeconómicos , Índice de Severidad de la Enfermedad , Chile/epidemiología , Factores de RiesgoRESUMEN
BACKGROUND: Bacteremic pneumococcal pneumonia (BPP) is a preventable disease with high morbimortality. AIM: To evaluate clinical aspects and mortality on BPP patients admitted to a Chilean regional hospital. PATIENTS AND METHODS: We looked for adult patients with Streptococcus pneumoniae isolated from blood cultures between 2010 and 2014 years and reviewed clinical records of those who were admitted with pneumonia. RESULTS: We identified 70 BPP patients: 58% were men, mean age was 56 years, 30% were > 65 years, 70% with basic public health insurance, 26% were alcoholics, 86% had comorbidities. Only two patients were vaccinated against S. pneumoniae. CURB-65 severity index for community acquired pneumonia was > 3 in 37% of patients. Twenty-four patients were admitted to ICU, twenty required mechanical ventilation and twenty-four died (34%). Mortality was associated with an age over 65 years, presence of comorbidities and complications of pneumonia. A total of 22 serotypes of S. pneumoniae were identified, five of them (1,3,7F,14 y 9V) were present in 57% of cases. CONCLUSIONS: Elevated mortality of our BNN patients was associated with comorbidities and possibly with socio economic factors, which conditioned a late access to medical care.
Asunto(s)
Bacteriemia/mortalidad , Neumonía Neumocócica/mortalidad , Anciano , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Ceftriaxona/uso terapéutico , Chile/epidemiología , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/mortalidad , Comorbilidad , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Neumonía Neumocócica/diagnóstico , Neumonía Neumocócica/tratamiento farmacológico , Neumonía Neumocócica/microbiología , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Streptococcus pneumoniae/aislamiento & purificaciónRESUMEN
Resumen Objetivo: Dimensionar la demanda de atención y/u hospitalización de la tuberculosis (TBC) en el Hospital de Puerto Montt (HPM). Método: Revisión retrospectiva de los registros de TBC del Servicio de Salud del Reloncaví (SSDR) y del HPM entre los años 2011 y 2015. Se incluyeron todos los casos de TBC activa vistos en forma ambulatoria u hospitalizada en el HPM. Resultados: Se diagnosticaron en el SSDR 298 casos de TBC, y de ellos un 64% (192/298) fue pesquisado en el HPM. Se presentan datos socioeconómicos, epidemiológicos, clínicos, de laboratorio y forma de diagnóstico de 180 casos, que cumplieron criterios de inclusión: varones 62%, edad media 44 ± 19 años. El 72% correspondieron al estrato social de menores ingresos, 4% indigentes, solo 14% poseía enseñanza media completa, 11% analfabetos, ruralidad 19%. Las principales co-morbilidades fueron alcoholismo (17%), VIH (12%), Diabetes (10%). En aquellos con TBC pulmonar o pleural (128) el tiempo con síntomas con frecuencia era prolongado (15% > 90 días) y la radiología mostraba enfermedad avanzada: infiltrados bilaterales 73%, compromiso > 3 lóbulos 55%, una o más cavitaciones 34%. Se hospitalizó el 71% (126/180), 50% por necesidad de estudio, 48%por gravedad. El 8% necesitó Unidad de Paciente Crítico (UPC). Fallecieron 24 pacientes (13%). Se asoció significativamente a mortalidad el analfabetismo y necesidad de UPC. Conclusiones: En el SSDR la TBC es un problema sanitario que afecta principalmente a poblaciones más pobres y vulnerables.
Backgroud: Tuberculosis (TB) is still a problem that impacts on hospitals of high complexity. Aim: To assess demand for care and/or hospitalization because of TB in Puerto Montt Hospital (PMH), located in the southern of Chile. Patients and Methods: Retrospective study of all Reloncaví Health Service (RHS) and PMH clinical records, between 2011 and 2015. We include all ambulatory or hospitalized cases of active TB registered in PMH during the period of the study. Results: In RHS there were 298 cases of TB and 64% of them (192/298) was detected in HPM. We present social, economic, epidemiological, clinical, laboratory studies, and specific type of diagnosis of 180 cases that met inclusion criteria: men 62%, mean age 45 ± 19 years-old. The population with lower income was 72%, 4% homeless, 14% with complete high school, 11% illiterate and 19% lived at country side. Main co-morbidities were alcoholism 17%, HIV 12%, Diabetes Mellitus 10%. In the specific group of lung/pleural TB (128 cases) the time with symptoms was often prolonged (15% > 90 days) and imagen studies showed advanced pathology: bilateral infiltrates 73%>, affecting three or more lobes 55%, cavitations 34%. 71% (126/180) were hospitalized, because of necessity of more study (50%) or severity (48%), 8% required to enter to the Critical Care Unit (CCU). Twenty-four patients died (13%). Illiteracy and the need for CCU were associated with mortality. Conclusions: In RHS TB is a sanitary problem that affects principally the most poor and vulnerable populations.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Tuberculosis/epidemiología , Factores Socioeconómicos , Tuberculosis/mortalidad , Tuberculosis/terapia , Chile , Estudios Retrospectivos , Factores de Riesgo , Poblaciones Vulnerables , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricosRESUMEN
Background: Bacteremic pneumococcal pneumonia (BPP) is a preventable disease with high morbimortality. Aim: To evaluate clinical aspects and mortality on BPP patients admitted to a Chilean regional hospital. Patients and Methods: We looked for adult patients with Streptococcus pneumoniae isolated from blood cultures between 2010 and 2014 years and reviewed clinical records of those who were admitted with pneumonia. Results: We identified 70 BPP patients: 58% were men, mean age was 56 years, 30% were > 65 years, 70% with basic public health insurance, 26% were alcoholics, 86% had comorbidities. Only two patients were vaccinated against S. pneumoniae. CURB-65 severity index for community acquired pneumonia was > 3 in 37% of patients. Twenty-four patients were admitted to ICU, twenty required mechanical ventilation and twenty-four died (34%). Mortality was associated with an age over 65 years, presence of comorbidities and complications of pneumonia. A total of 22 serotypes of S. pneumoniae were identified, five of them (1,3,7F,14 y 9V) were present in 57% of cases. Conclusions: Elevated mortality of our BNN patients was associated with comorbidities and possibly with socio economic factors, which conditioned a late access to medical care.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Neumonía Neumocócica/mortalidad , Bacteriemia/mortalidad , Neumonía Neumocócica/diagnóstico , Neumonía Neumocócica/microbiología , Neumonía Neumocócica/tratamiento farmacológico , Factores Socioeconómicos , Streptococcus pneumoniae/aislamiento & purificación , Índice de Severidad de la Enfermedad , Ceftriaxona/uso terapéutico , Comorbilidad , Chile/epidemiología , Factores de Riesgo , Mortalidad Hospitalaria , Bacteriemia/microbiología , Bacteriemia/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/mortalidad , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Antibacterianos/uso terapéuticoRESUMEN
Background: There is paucity of information about viral etiology of community acquired pneumonia in adults. Aim: To investigate the viral etiology of pneumonia among hospitalized patients. Material and Methods: All adults with pneumonia that were hospitalized were prospectively enrolled at Puerto Montt hospital. A microbiological and viral assessment was carried out. Viral assessment included direct immunofluorescence of nasopharyngeal aspirates for influenza A and B virus and serum samples obtained during the acute phase of the disease and during convalescence for Hanta virus. Results: Between April 1 2005 and March 31 2006,159 adults aged 62 ± 20 years (58 % males), were admitted to the hospital for pneumonia. Mean hospital stay was 11.9 ± 8.6 days. Four patients had Hantavirus acute infection. Other viruses were identified in twelve patients (7.7%). Nine had influenza A, one syncytial respiratory virus, one syncytial and influenza A virus and one varicella zoster virus. Excluding patients with Hantavirus, no significant differences in age, clinical presentation, chest X ray findings, laboratory results and mortality were observed between patients with bacterial or viral etiology of the pneumonia. Conclusions: Viral etiology was confirmed in 10% of adult patients hospitalized with community acquired pneumonia.
Asunto(s)
Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/virología , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/virología , Hospitalización , Hospitales Generales , Neumonía Viral/diagnóstico , Neumonía Viral/microbiología , Estudios ProspectivosRESUMEN
BACKGROUND: There is paucity of information about viral etiology of community acquired pneumonia in adults. AIM: To investigate the viral etiology of pneumonia among hospitalized patients. MATERIAL AND METHODS: All adults with pneumonia that were hospitalized were prospectively enrolled at Puerto Montt hospital. A microbiological and viral assessment was carried out. Viral assessment included direct immunofluorescence of nasopharyngeal aspirates for influenza A and B virus and serum samples obtained during the acute phase of the disease and during convalescence for Hanta virus. RESULTS: Between April 1 2005 and March 31 2006,159 adults aged 62 ± 20 years (58 % males), were admitted to the hospital for pneumonia. Mean hospital stay was 11.9 ± 8.6 days. Four patients had Hantavirus acute infection. Other viruses were identified in twelve patients (7.7%). Nine had influenza A, one syncytial respiratory virus, one syncytial and influenza A virus and one varicella zoster virus. Excluding patients with Hantavirus, no significant differences in age, clinical presentation, chest X ray findings, laboratory results and mortality were observed between patients with bacterial or viral etiology of the pneumonia. CONCLUSIONS: Viral etiology was confirmed in 10% of adult patients hospitalized with community acquired pneumonia.
Asunto(s)
Neumonía Viral/virología , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/virología , Femenino , Hospitalización , Hospitales Generales , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , Neumonía Viral/microbiología , Estudios ProspectivosRESUMEN
BACKGROUND: Pandemic flu (H1N1 ) strongly affected southern Chile during 2009. AIM: To report the logistic and organizational changes implemented at a regional hospital to face the pandemic. MATERIAL AND METHODS: All patients with flu like disease that were hospitalized, were prospectively enrolled at the Puerto Montt hospital. A nasopharyngeal aspirate was obtained in all for influenza virus A and B direct immunofluorescence and polymerase chain reaction (PCR). All epidemiological and clinical data of patients were recorded. RESULTS: Between May 29 and July 7, 2009, 184 adults were admitted to the hospital and in 117 patients aged 41 ± 18 years (56% females ), direct immunofluorescence was positive for influenza. In 67 of these patients PCR did not confirm the disease. These unconfirmed patients had a mean age of 49 ± 19 years (p < 0.01, compared with confirmed cases) and had a lower frequency of fever, rhinorrhea and chills. No significant differences in the incidence of community acquired pneumonia or chest X ray findings were observed between confirmed and unconfirmed cases. Hospital stay was over 15 days in 14% of confirmed cases and 5% of unconfirmed cases (p = 0.03). Fifteen patients, aged 53 ± 18 years, died. CONCLUSIONS: Low sensibility of direct immunofluorescence and delay in obtaining PCR confirmation of influenza posed a problem for the management of these patients.
Asunto(s)
Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/epidemiología , Gripe Humana/virología , Pandemias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Chile/epidemiología , Femenino , Técnica del Anticuerpo Fluorescente Directa , Hospitalización , Humanos , Gripe Humana/diagnóstico , Masculino , Persona de Mediana Edad , Nasofaringe/virología , Estudios Prospectivos , Reacción en Cadena en Tiempo Real de la Polimerasa , Adulto JovenRESUMEN
Background: Pandemic flu (H1N1 ) strongly affected southern Chile during2009. Aim: To report the logistic and organizational changes implemented at a regional hospital to face the pandemic. Material and Methods: All patients with flu like disease that were hospitalized, were prospectively enrolled at the Puerto Montt hospital. A nasopharyngeal aspirate was obtained in all for influenza virus A and B direct immunofluorescence and polymerase chain reaction (PCR). All epidemiological and clinical data of patients were recorded. Results: Between May 29 and July 7, 2009, 184 adults were admitted to the hospital and in 117patients aged 41 ± 18 years (56 percent females ), direct immunofluorescence was positive for influenza. In 67 of these patients PCR did not confirm the disease. These unconfirmed patients had a mean age of 49 ± 19 years (p < 0.01, compared with confirmed cases) and had a lower frequency of fever, rhinorrhea and chills. No significant differences in the incidence of community acquired pneumonia or chest X ray findings were observed between confirmed and unconfirmed cases. Hospital stay was over 15 days in 14 percent of confirmed cases and 5 percent of unconfirmed cases (p = 0.03). Fifteen patients, aged 53 ± 18 years, died. Conclusions: Low sensibility of direct immunofluorescence and delay in obtaining PCR confirmation of influenza posed a problem for the management of these patients.
Asunto(s)
Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/epidemiología , Gripe Humana/virología , Pandemias , Chile/epidemiología , Técnica del Anticuerpo Fluorescente Directa , Hospitalización , Gripe Humana/diagnóstico , Nasofaringe/virología , Estudios Prospectivos , Reacción en Cadena en Tiempo Real de la PolimerasaRESUMEN
We report a previously healthy 36-year-old mole who developed a pulmonary syndrome caused by Hantavirus infection. He was admitted to an intensive care unit in shock and respiratory failure and died four hours after admission. Blood cultures were positive for Staphylococcus aureus. This patient could be an index case that shows, for the first time, an association of Hantavirus Pulmonary Syndrome with Staphylococcus aureus infection similar to what happens with other viruses.
Asunto(s)
Síndrome Pulmonar por Hantavirus/complicaciones , Sepsis/microbiología , Infecciones Estafilocócicas/complicaciones , Staphylococcus aureus , Adulto , Resultado Fatal , Síndrome Pulmonar por Hantavirus/patología , Humanos , Masculino , Sepsis/patología , Infecciones Estafilocócicas/patologíaRESUMEN
We report a previously healthy 36-year-old mole who developed a pulmonary syndrome caused by Hantavirus infection. He was admitted to an intensive care unit in shock and respiratory failure and died four hours after admission. Blood cultures were positive for Staphylococcus aureus. This patient could be an index case that shows, for the first time, an association of Hantavirus Pulmonary Syndrome with Staphylococcus aureus infection similar to what happens with other viruses.
Asunto(s)
Adulto , Humanos , Masculino , Síndrome Pulmonar por Hantavirus/complicaciones , Sepsis/microbiología , Infecciones Estafilocócicas/complicaciones , Staphylococcus aureus , Resultado Fatal , Síndrome Pulmonar por Hantavirus/patología , Sepsis/patología , Infecciones Estafilocócicas/patologíaRESUMEN
BACKGROUND: Community acquired pneumonia (CAP) in the elderly has unique features and there is little information about the effects of nutrition status on its outcome. AIM: To assess the clinical manifestations and prognostic factors of CAP in immunocompetent elderly patients requiring hospitalization. PATIENTS AND METHODS: Prospective study of all patients with CAP, admitted to Puerto Montt Hospital, Chile over one year. Epidemiológica! and clinical information and laboratory results were recorded. A nutritional assessment was also performed. Outcomes of elderly (>65 years) and young patients were compared. RESULTS: Two hundred patients aged 63+/- 19 years were studied. Of these, 109 were older than 65 years (78.4+/-8 years) and 91 were younger than 65 years (45.5+/-11 years). Multiple associated diseases, altered mental status, absence of fever, malnutrition and mortality were more common in the older group. Suspected aspiration pneumonia was more common in younger patients, probably related to alcoholism. Malnutrition was associated with longer hospital stay and mortality at any age. An univariate analysis showed that a low serum albumin (<3.4 g/dl) and a mid arm muscle circumference below the 25th percentile were associated with higher mortality. CONCLUSIONS: CAP in the elderly has specific features and malnutrition is associated with a worse prognosis in young and elderly patients.
Asunto(s)
Evaluación Geriátrica , Estado Nutricional , Neumonía Bacteriana , Factores de Edad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/fisiopatología , Femenino , Humanos , Tiempo de Internación , Masculino , Desnutrición/fisiopatología , Persona de Mediana Edad , Evaluación Nutricional , Estado Nutricional/fisiología , Neumonía Bacteriana/microbiología , Neumonía Bacteriana/fisiopatología , Pronóstico , Estudios Prospectivos , Albúmina Sérica/análisisRESUMEN
Community acquired pneumonia (CAP) in the elderly has unique features and there is little information about the effects of nutrition status on its outcome. Aim: To assess the clinical manifestations and prognostic factors of CAP in immunocompetent elderly patients requiring hospitalization. Patients and methods: Prospective study of all patients with CAP, admitted to Puerto Montt Hospital, Chile over one year. Epidemiológica! and clinical information and laboratory results were recorded. A nutritional assessment was also performed. Outcomes of elderly (>65 years) and young patients were compared. Results: Two hundred patients aged 63± 19 years were studied. Of these, 109 were older than 65 years (78.4±8 years) and 91 were younger than 65years (45.5±11 years). Multiple associated diseases, altered mental status, absence of fever, malnutrition and mortality were more common in the older group. Suspected aspiration pneumonia was more common in younger patients, probably related to alcoholism. Malnutrition was associated with longer hospital stay and mortality at any age. An univariate analysis showed that a low serum albumin (<3.4 g/dl) and a mid arm muscle circumference below the 25th percentile were associated with higher mortality. Conclusions: CAP in the elderly has specific features and malnutrition is associated with a worse prognosis in young and elderly patients.
Asunto(s)
Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación Geriátrica , Estado Nutricional , Neumonía Bacteriana , Factores de Edad , Análisis de Varianza , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/fisiopatología , Tiempo de Internación , Desnutrición/fisiopatología , Evaluación Nutricional , Estado Nutricional/fisiología , Neumonía Bacteriana/microbiología , Neumonía Bacteriana/fisiopatología , Pronóstico , Estudios Prospectivos , Albúmina Sérica/análisisRESUMEN
BACKGROUND: Community-acquired pneumonia (CAP) is a common and serious illness in Chile. AIM: To evaluate the etiology, severity, prognostic factors and blood culture yield of CAP requiring hospitalization in Puerto Montt in Southern, Chile. PATIENTS AND METHODS: All non immunocompromised adults with CAP admitted at Puerto Montt Hospital during one year, were prospectively studied. Clinical and radiological assessment was done in all patients. Blood and sputum cultures were obtained and serology for atypical agents was determined. RESULTS: We studied 200 patients, aged 63+/-19 years (109 males). The prognostic factors associated with mortality were an age over 65 years, an altered mental status, shock and acute renal failure. Etiology was demonstrated in 29% of patients. The most frequent pathogens were Streptococcus pneumoniae (40.7%), Haemophilus influenzae (23.7%) and Chlamydia pneumoniae (16.9%). Mixed infections were found in 17%. Fifteen atypical pathogens were identified in 12 patients. Of these only two received a specific treatment but no one died and their length hospital stay was similar than in the rest of the patients. Overall, blood cultures were positive in 12.5% of patients, but among alcoholics, 58% were positive. In only one percent of cases, positive cultures motivated therapeutic changes among clinicians. Eight percent of S pneumoniae strains were penicillin resistant. CONCLUSIONS: Atypical agents were a common cause of CAP in this group of patients, but their pathogenic role and treatment requirements are debatable. Focusing blood cultures on specific groups could improve their yield. The rate of Penicillin resistance for S pneumoniae was.
Asunto(s)
Infecciones Neumocócicas/microbiología , Neumonía Bacteriana/microbiología , Adolescente , Adulto , Factores de Edad , Anciano , Chile/epidemiología , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Métodos Epidemiológicos , Femenino , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Gramnegativas/microbiología , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Resistencia a las Penicilinas , Penicilinas/uso terapéutico , Infecciones Neumocócicas/epidemiología , Neumonía Bacteriana/epidemiología , PronósticoRESUMEN
Asthma is a disease with a variable clinical behaviour and usually insufficiently treated and managed. Methods: An Asthma Control Program was implemented in Puerto Montt, Chile, with the out patient participation of the primary medical care system. This Program classifies the asthmatic patients by using preestablished criteria of severity. We analyzed the evolution of 135 patients through six quarterly medical controls covering 18 months of follow up. Results: Patients diminished progressively and significantly their severity levels and their daily and nocturnal symptoms. Besides a significant increase of physical capacity (p = 0.001) and peak expiratory flow (PEF) (p = 0.0001) was observed. A series of severe asthmatic patients (12.5 percent) was identified. This group concentrated most of the emergency consultations and hospitalizations. Conclusions: An organized management of asthmatic patients has allowed us to show objectively clinical improvements in these patients after entering to this program
El asma es una patología de comportamiento clínico variable y generalmente sub tratada. Material y métodos: En Puerto Montt se implementó un Programa de Control de Asma Bronquial integrado con el nivel primario de atención, que clasifica los pacientes usando criterios de gravedad. Se analizó la evolución de 135 asmáticos en 6 controles trimestrales cubriendo 18 meses de seguimiento. Resultados: Hubo disminución progresiva y significativa de los niveles de severidad, de síntomas diurnos y nocturnos, aumento de la capacidad de ejercicio (p = 0,001) y del flujo espiratorio máximo (PEF) (0,0001). Se identificó un subgrupo de asmáticos graves (12,5 por ciento) responsables de la gran mayoría de las consultas en urgencia y de las hospitalizaciones. Conclusiones: El manejo organizado de los pacientes asmáticos permitió obtener ventajas clínicas objetivables
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Humanos , Niño , Asma/prevención & control , Planes y Programas de Salud , Índice de Severidad de la Enfermedad , Asma/clasificación , Asma/terapia , Chile , Evolución Clínica , Estudios de Seguimiento , Hospitalización/estadística & datos numéricos , Interpretación Estadística de DatosRESUMEN
Background: Community-acquired pneumonia (CAP) is a common and serious illness in Chile. Aim: To evaluate the etiology, severity, prognostic factors and blood culture yield of CAP requiring hospitalization in Puerto Montt in Southern, Chile. Patients and methods: All non immunocompromised adults with CAP admitted at Puerto Montt Hospital during one year, were prospectively studied. Clinical and radiological assessment was done in all patients. Blood and sputum cultures were obtained and serology for atypical agents was determined. Results: We studied 200 patients, aged 63±19 years (109 males). The prognostic factors associated with mortality were an age over 65 years, an altered mental status, shock and acute renal failure. Etiology was demonstrated in 29% of patients. The most frequent pathogens were Streptococcus pneumoniae (40.7%), Haemophilus influenzae (23.7%) and Chlamydia pneumoniae (16.9%). Mixed infections were found in 17%. Fifteen atypical pathogens were identified in 12 patients. Of these only two received a specific treatment but no one died and their length hospital stay was similar than in the rest of the patients. Overall, blood cultures were positive in 12.5% of patients, but among alcoholics, 58% were positive. In only one percent of cases, positive cultures motivated therapeutic changes among clinicians. Eight percent of S pneumoniae strains were penicillin resistant. Conclusions: Atypical agents were a common cause of CAP in this group of patients, but their pathogenic role and treatment requirements are debatable. Focusing blood cultures on specific groups could improve their yield. The rate of Penicillin resistance for S pneumoniae was low.
Asunto(s)
Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infecciones Neumocócicas/microbiología , Neumonía Bacteriana/microbiología , Factores de Edad , Chile/epidemiología , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Métodos Epidemiológicos , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Gramnegativas/microbiología , Hospitalización/estadística & datos numéricos , Resistencia a las Penicilinas , Penicilinas/uso terapéutico , Infecciones Neumocócicas/epidemiología , Neumonía Bacteriana/epidemiología , PronósticoRESUMEN
Background: The emergence and dissemination of resistance to penicillin among Streptococcus pneumoniae changed the approach to empiric antimicrobial therapy. Aim: To evaluate the in vitro susceptibility to penicillin in all S. pneumoniae strains isolated in Puerto Montt Hospital between 1995 and 2003. Material and methods: We revised all Microbiology Laboratory files of this period. Identification and antimicrobial susceptibility study methods for S pneumoniae did not change during the study period. Results: Six hundred eighteen S pneumoniae strains were identified. Of these, 66% came from adults and 48% from invasive diseases. Only 1.9% of strains were penicillin resistant and 7.6% had intermediate sensibility. Strains isolated from children and those isolated from non sterile sources had non significantly higher resistance levels. The susceptibility did not change along the years of the study. Conclusions: Among S pneumoniae strains isolated at Puerto Montt Hospital, the prevalence of penicillin resistance is low.