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Las aeromonas son bacilos gram negativos móviles que fermentan los carbohidratos;son oxidasa positivo y crecen bien en los medios de cultivo para aislar enterobacteriaceaes. Actualmente las aeromonas son señaladas como agente etiológico de una variedad de procesos infecciosos que amenazan la vida de los pacientes.

Durante el mes de febrero hubo 843 casos de EDA en pediatría, de los cuales se cultivaron 272 pacientes (32%). De ellos, se recuperó V. cholerae 01 en 137 pacientes (50.4%). Se utilizaron estos grupos con el objeto de comparar características de la diarrea por V. cholerae. En los pacientes con V. cholerae la edad promedio fuesignificativamente mayor, 67.5m vs. 43.5m (p

La infección urinaria (ITU) en pediatría es frecuente y el tratamiento antibiótico inicial es empírico, basado en la sensibilidad conocida de las bacterias del medio. Para averiguar dicha sensibilidad, se seleccionaron 61 pacientes entre 4 meses y 13 años, que acudieron alServicio de Emergencia Pediátrica del Hospital Nacional Cayetano Heredia, con cuadro clínico de ITU y urocultivo positivo. Las bacterias aisladas fueron: Escherichia coli, en 49 cultivos (80.3%), Klebsiella sp. En 10 cultivos (16.4%) y Proteus mirabilis en 2 casos (3.3%). La sensibilidad in vitro fue de un 100% a gentamicina, ceftriaxone, ceftazidime, y norfloxacina; 95.9% a amikacina, 94.1% a nitrofurantoina, 91.4% a ácido nalidixico, 81.7% a cefalotina, 46.6% a cotrimoxazole, y 18.8% a ampicilina.

Objetivo: Evaluar la prevalencia de Streptococcus pneumoniae resistente a penicilina (SPRP). Material y métodos: Se realizó un estudio transversal, multicéntrico, entre Noviembre de 1993 y Noviembre de 1994. Cultivos de sangre, líquido cefalorraquídeo (LCR), líquido pleural (LP), material de timpanocentesis y esputo fueron coleccionados de los laboratorios de microbiología de cuatro hospitales de Lima. Las pruebas de concentración inhibitoria mínima (CIM), fueron realizados usando métodos de dilución en agar, en el laboratorio del Instituto de Medicina Tropical. Se aislaron 61 cepas. Resultados: Solo 2 (3.3%) fueron resistentes a penicilina (SPRP), con CIM > 0.12 µg/mL. Las otras 59(96.7%) fueron susceptibles a penicilina (CIM: 0.006 - 1.00 µg/mL), no se encontraron cepas con alto nivel de resistencia a penicilina (CIM ≥ 2.0 µg/mL). Ambas cepas fueron susceptibles a cefotaxime (CIM = 0.251µg/mL), a trimethoprim/sulfametoxazole (CIM = 8 µg/mL, 16 µg/mL) y a cloramfenicol (CIM =1.0 µg/mL), pero fueron resistentes a ampicilina (CIM = 0.5 µg/mL, 1 µg/mL). Cuatro (6.6%) cepas de Streptococcus pneumoniae fueron resistentes a ampicilina, (CIM: 0.06 - 4.00 µg/mL). Solo 1 (1.7%) fue resistente a trimethoprim/sulfamethoxazole, (CIM: 1.0 - 32.0 µg/mL). Todas las 61 cepas fueron susceptibles a cefotaxime (CIM: 0.007 - 0.251 µg/mL). (Rev Med Hered 1996; 7: 11-16). Objective: To evaluate the prevalence of resistance of Streptococcus pneumoniae strains to penicillin. Material y methods: A multicentric transversal survey was performance between November 1993 to November 1994, in four hospitals of Lima-Perú. Samples of sputum, blood, CSF, and other fluids were collected from the microbiology laboratories of those centers. Susceptibility tests of the strains were performed by conventional methods in the laboratory of the Instituto de Medicina Tropical, 61 strains were included. Results: Only 2 (3.3%) of the strains isolated were resistant (minimal inhibitory concentration, MIC>0.12 µg/mL). No high level resistant strains (MIC >2.0 µg/mL) were found in these samples. The other 59 (97.8%) strains were susceptible to penicillin (MIC range: 0.006-1.0 µg/mL). Both penicillin-resistant strains were susceptible to cefotaxime (MIC = 0.251 µg/mL), trimethoprin/sulfamethoxazole (MIC = 8 µg/mL, 16 µg/mL), chloramphenicol (MIC = 1.0 µg/mL); Both strains were resistant to ampicillin, (MIC = 0.5 µg/mL, 1µg/mL). Four (6.6%) strains were resistant to ampicillin, (MIC: 0.06 - 4.0 µg/mL). One strain was (1.7%) resistant to Chloramphenicol, (MIC: 1.0 - 32.0 µg/mL). Only 1 (1.7%) was resistant to Trimethoprin/Sulfamethoxazole, (MIC: 1.00 - 32 µg/mL). All the strains were susceptible to Cefotaxime (MIC range: 0.007-0.251 µg/mL). (Rev Med Hered 1996; 7: 11-16).

Objetivo: Investigar la prevalencia de prácticas sexuales de riesgo para infección por Enfermedades de Transmisión Sexual (ETS) y la seroprevalencia de infección por VIH-1, HTLV-1 y Treponema pallidum en meretrices de los burdeles clandestinos de Lima. Material y métodos: Estudio de diseño transversal, descriptivo y no probabilístico. Se realizó una encuesta anónima por entrevista directa sobre prácticas sexuales y antecedentes de ETS y se tomó una muestra de sangre para análisis serológico de anticuerpos contra VIH-1, HTLV-1 y T. Pallidum de 158 meretrices voluntarias en 15 burdeles clandestinos de Lima Metropolitana entre marzo y junio de 1994. Resultados: Todas las muestras de suero fueron negativas para VIH-1 (IC 95%, 0.0 - 1.8) pero dos resultaron indeterminadas (ELISA positivo y WB banda p24 presente). Seis (3.8%) positivas para HTLV-1 (IC 95%, 1.4 - 8.1). Cinco (3.2%) fueron VDRL reactivas (IC 95%, 1.0 - 7.3). El uso consistente de condón con los clientes fue 75% (119/158). Sólo 3% (4/137) lo usan con su pareja sexual estable. Las prácticas sexuales de riesgo encontradas fueron: coito anal 7.6%, relaciones sexuales durante la menstruación 37%, felación 93%, relaciones sexuales con clientes portadores de úlceras genitales 19%; pero refirieron un mayor uso del condón en las mismas. El 25% tuvo antecedentes de alguna ETS en los últimos 5 años, siendo gonorrea, la más frecuente (22%). Conclusiones: La población de meretrices de los burdeles clandestinos de Lima tiene un elevado uso consistente del condón con clientes, y la prevalencia de infección retroviral y de sífilis es baja. (Rev Med Hered 1996; 7: 162-171). Objetive: To investigate the prevalence of sexual practices with risk to sexually transmitted diseases (STD) and the seroprevalence of HIV-1, HTLV-1 and syphilis in non-registered prostitutes in Lima. Material and methods: A transversal, descriptive and non-registered prostitutes in Lima between March and June of 1994. Results: All serum samples were negative for HIV-1, but two samples had indeterminate results (positive ELISA and WB p24 band present). Six (3.8%), were HTLV-1 positive (CI 95%, 1.4-8.1) and 5 VDRL reactives (CI 95%, 1.7-7.3). Regular condom use was found in 75%, but only 3% with permanent partners. Sexual practices with risk were: annal sex 7.9%, sex during menstrual bleeding 37%, oral sex 93% and sex with genital ulcer carrier 19%. STD antecedent in the last 5 years was found in 25%, gonorrhea was most frequent. Conclusions: High regular condom use and low retroviral infections and syphilis were found in non-registered female prostitutes in Lima. (Rev Med Hered 1996; 7: 162-171).

Rectal swabs from 391 infants less than 18 months of age who were hospitalized with acute diarrhea and from 138 similarly aged healthy infants were examined for the etiologic agents of diarrhea. Aeromonas spp. were recovered from 205 of 391 (52.4%) diarrheic patients, whereas they were recovered from 12 of 138 (8.7%) controls (P less than 10(-11). Among the 205 Aeromonas-positive diarrheic patients, 118 (57.6%) were found to be coinfected with other common enteropathogens. Of the 164 Aeromonas-positive initial diarrheic specimens, 82 (50.0%) had one or more other enteropathogens present; 30 patients were coinfected with rotavirus, 20 with enterotoxigenic Escherichia coli, 16 with Campylobacter spp., 14 with Shigella spp., 13 with enteropathogenic E. coli, 4 with Vibrio spp., 1 with Salmonella spp., and 1 with Plesiomonas spp. of Aeromonas strains from cases compared with that from controls supports an etiologic role for this organism. However, frequent concomitant infections with other well-recognized enteropathogens and a lack of disease correlation with common Aeromonas phenotypes suggest that only a subset of Aeromonas strains may be diarrhea causing and that such strains may be common to several of the existing species.

Surveillance was conducted during February and March 1991 in the pediatric emergency department of Cayetano Heredia Hospital, Lima, Peru, to contrast the characteristics of children with epidemic cholera with those of children with noncholera-associated diarrhea. Among 626 patients 14 years of age or younger, Vibrio cholerae O1 was isolated from stool specimens of 310 patients (49%), more commonly from children older than 24 months of age (66%; p < 0.0001) than from younger children. Cholera was clinically characterized by a more sudden onset; watery diarrhea; and associated abdominal pain, muscle cramps, and vomiting, which led to more severe dehydration and hospitalization more often than in noncholera cases. Only one patient with cholera died, for a case-fatality rate of 3.2 deaths per 1000 persons. Nonpotable water and uncooked foods were identified as probable vehicles for V. cholerae. The frequency of diarrhea among relatives of patients with cholera suggested intrafamily transmission. This study of epidemic cholera describes the clinical features and the risk factors for acquisition of the infection, and points out the low case-fatality rate with prompt and appropriate treatment.

In a longitudinal study of acute and persistent diarrhea in 677 children less than three years old in a peri-urban community of Lima, Peru, during 27 months of surveillance, stools were cultured at the beginning of each diarrheal episode and on each subsequent week of illness. Analyzing stool cultures only from children who had not received antibiotic treatment in the 48 h prior to the culture, no association was found between any enteropathogen and persistent diarrhea. We did not find any increase in mixed infections in persistent diarrhea episodes as compared with acute diarrhea, controlling for age, season and anthropometric status. The isolation rate for any given enteropathogen was similar during the first, second, third or later week of illness, but when the presence of a specific enteropathogen was sought in sequential stools within a single episode, no evidence of persistent infection was found. This study shows that in developing countries with a high incidence of diarrheal diseases frequent re-infections with enteropathogens prevalent in the population are one reason for prolonged illnesses. Host factors that increase susceptibility to infection or decrease recovery from illness may also play a role. Further studies of these factors, such as micronutrient deficiencies, are needed to identify a public health intervention to control persistent diarrhea, a condition associated with mortality in many developing countries.

In a double-blind, ramdomized trial, we compared the efficacy of bicarbonate-containing oral rehydration solution vs citrate-containing solution in the treatment of infantile diarrheal dehydration and acidosis. Ninety-seven infants 3 to 24 months of age were entered in the study; 49 received bicarbonate-containing solution and 48 citrate-containing solution. The two groups were similar in all respects at the beginning of the study. Oral rehydration was successful (i.e., no intravenously administered fluids were required) in 85% of study patients; the success rate was similar in both treatment groups. Serum total CO 2 concentration increased in a similar fashion in both groups, reaching near normal values at 48 hours after admission. We conclude that sodium citrate can be substituted for sodium bicarbonate in the formulation of the orally administered rehydration solution recommended by the World Health Organization for treatment of diarrheal dehydration in infants.

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