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We present the case of a 59-year-old male patient diagnosed with HIV infection since 2008 on intermittent antiretroviral therapy with dolutegravir, lamivudine, abacavir, stage C3 (viral load 29,855 and CD4 count 40) who was admitted for a clinical picture of two months of evolution consisting of the appearance of non-pruritic nodular ulcerated cutaneous lesions on the face and lower limbs associated with loss of visual acuity in the left eye. On physical examination presented ulcerated lesions with necrotic and hyperkeratotic edges, for this reason extension studies were requested. The patient presented reactive VDRL, which is why a skin biopsy was requested, due to the suspicion of malignant syphilis, as well as lumbar puncture and ophthalmological assessment, which confirmed neurosyphilis and panuveitis. Finally, the skin biopsy report showed lesions compatible with malignant syphilis, for which he was treated with single-dose benzathine penicillin G and crystalline penicillin due to central nervous system and eye involvement, with complete resolution of the symptoms. [ABSTRACT FROM AUTHOR]

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Objetivos: Confirmar la presencia de alergia a penicilina y amoxicilina mediante pruebas de exposición in vivo, en pacientes que refieren antecedente de reacción inmediata con estos medicamentos. Métodos: Estudio observacional, transversal, descriptivo y prolectivo. Se incluyeron pacientes entre 12 y 60 años con antecedente de reacción inmediata tras administración de penicilina y/o amoxicilina. Se realizaron pruebas cutáneas por prick e intradérmicas con bencilpeniciloil polilisina y penicilina G, así como desafío oral con amoxicilina. Resultados: Se incluyeron 10 pacientes femeninos y 3 masculinos. La edad promedio fue 39 años. En 84,6% de los casos la última reacción adversa a medicamentos ocurrió 10 años atrás y en todos los casos se manifestó con urticaria. Sólo en el 38,4% se corroboró alergia a penicilina. La reacción adversa más frecuente, tras las pruebas de exposición in vivo fue prurito en el 23%. Conclusiones: Los pacientes con sospecha de alergia a penicilina se deben evaluar mediante pruebas de exposición in vivo con los determinantes mayores y menores, para corroborar o descartar reacciones alérgicas y mejorar las condiciones de tratamiento.

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Self-reported penicillin allergy is highly prevalent. Different studies estimate that 10% of the population is labeled as such. This label, confirmed or suspected, forces us to take precautions and replace the antibiotic treatment of choice (frequently beta-lactams) with other 2nd or 3rd choice alternatives with worse overall results: side effects, resistance, costs, etc. The penicillin allergy label, once placed, remains in the medical record. It is only confirmed in less than 5% of patients, either because it has been placed inappropriately or because over time the sensitivity decreases and may disappear. Penicillin Allergy Decision Rule -PEN-FAST- is a validated and simple clinical prediction rule that estimates the risk of presenting an allergic reaction. Its use, together with algorithms that involve primary care in the study and delabeling of low-risk patients, can change our clinical practice., (Copyright © 2024 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Copyright of Revista de Ciencias Médicas de Pinar del Río is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Betalactams are the most widely used antimicrobials for their safety and efficacy. These include the penicillins, cephalosporins, carbapenems, and monobactams. Penicillin allergy ranks first in relation to drug allergy. 10 to 20 % of the population is labeled as allergic to it, often wrongly. Cross reaction is reported in 2 to 5 % between penicillins and cephalosporin. There is no cross reaction between penicillins and aztreonam, but there is with ceftazidime. All the mechanisms of the Gell and Coombs classification are included in the pathophysiology of hypersensitivity reactions to penicillin. Stratification according to risk allows us to take the most objective behavior to label the patient as allergic to. In the natural history of penicillin allergy, 80-90 % of patients lose this sensitivity by 10 years. If necessary, the patient can undergo a desensitization protocol. The immuno-allergist is a key piece in the selection of the patient, the elaboration of the challenge and desensitization protocols, in a controlled environment. [ABSTRACT FROM AUTHOR]

Los betalactámicos son los antimicrobianos más utilizados por su seguridad y eficacia. En este grupo se incluyen las penicilinas, las cefalosporinas, los carbapenémicos y los monobactámicos. La penicilina constituye la primera causa de alergia a medicamentos: 10 a 20 % de la población se etiqueta como alérgica a la misma, en muchas ocasiones erróneamente. Se ha reportado reacción cruzada entre penicilinas y cefalosporina en 2 a 5 %. No hay reacción cruzada entre penicilinas y aztreonam, pero sí con ceftazidima. En la fisiopatología de las reacciones de hipersensibilidad a penicilina se incluyen todos los mecanismos de la clasificación de Gell y Coombs. La estratificación de acuerdo con el riesgo permite tomar la decisión más objetiva para etiquetar al paciente como alérgico. En la evolución natural de la alergia a la penicilina, 80 a 90 % de los pacientes pierde dicha sensibilidad a los 10 años. De ser indispensable, el paciente puede ser sometido a un protocolo de desensibilización. El médico inmunoalergologo es una pieza clave en la selección del paciente, la elaboración de los protocolos de reto y la desensibilización en un ambiente controlado.

Introduction. Congenital syphilis is a well-known infectious disease caused by the passing of Treponema pallidum from the infected mother to the fetus. In most cases, it leads to fetal death. Still, in the survivors, it can manifest clinically as early congenital syphilis in the first two years of life or late congenital syphilis after ward. Current epidemiological data suggest that the incidence is very low in developed countries due to screening. Case report. We report the case of a 2-month-old male infant who presented with a sepsis-like picture, generalized edema, and hepatosplenomegaly. He had elevated inflammatory markers (C-reactive protein and procalcitonin), acute kidney injury, and fulminant liver failure. The radiographic exam revealed periostitis of the long bones. The brain magnetic resonance imaging (MRI) revealed encephalitis, ventriculomegaly and cerebral atrophy, suggesting neurosyphilis. The diagnosis of congenital syphilis was confirmed by the positive Venereal Disease Research Laboratory (VDRL) test. We initiated the treatment with penicillin, then we associated ceftriaxone for neurological involvement. He also needed blood transfusions due to severe anemia and thrombocytopenia, diuretics, and hydrocortisone treatment. Conclusions. There are cases when screening methods are omitted, therefore congenital syphilis should always be considered in the differential diagnosis of sepsis in young infants. [ABSTRACT FROM AUTHOR]

Existe una gran diversidad de hongos que poseen actividad medicinal en Centroamérica y de ellos se pueden extraer los metabolitos secundarios responsables y adecuados para el tratamiento de distintas enfermedades. En esta revisión se realizó una investigación acerca de seis hongos específicos que se utilizan para el tratamiento de padecimientos físicos: Penicillium chrysogenum (P. chrysogenum), Ganoderma lucidum (G. lucidum), Trametes versicolor (T. versicolor), Schizophyllum commune (S. commune), Pleurotus mutilus (P. mutilus), Lentinula edodes (L. edodes), y un último hongo que tiene propiedades alucinógenas útiles en el tratamiento de enfermedades mentales: Psilocybe cubensis (P. cubensis). Se encontró que los metabolitos secundarios de mayor importancia para la industria médica son la penicilina y la tiamulina como antibióticos, los triterpenos por su actividad anticancerígena, diversos tipos de polisacáridos que tienen actividad antioxidante, antiparasitarios, estimulantes del sistema inmune y reguladores del colesterol. Asimismo, se estudió el alucinógeno psilocibina y su potencial en tratamientos de psicoterapia.

Streptococcus agalactiae (GBS) cause severe infections in newborns under three months. Meningitis, pneumonia and sepsis are the main infectious diseases in these children. These infections are among the most serious that an individual can suffer in his first twelve hours of life. The child acquires the infection by vertical transmission of the colonized mother. To prevent neonatal disease, penicillin is recommended as the drug of choice for intrapartum prophylaxis (PIP) in pregnant women colonized. However, strains with decreased susceptibility to penicillin have been detected so it is important to monitor the susceptibility to penicillin to ensure its usefulness during prophylaxis. The aim of this study was to determine the sensitivity to penicillin in GBS strains recovered from pregnant women with 35-37 weeks of gestation. Ninety-six isolates were studied and sensitivity was determined by the epsilometric method Etest® (LIOFILCHEM, Italy), following the recommendations of the Clinical Laboratory Standards Institute (CLSI). Minimum Inhibitory Concentration (MIC) was obtained for each bacterial isolation. 100% (96) of the strains studied were sensitive to penicillin with MIC values between 0.012 and 0.094 ?g mL-1. These results indicate that penicillin remains the antimicrobial of choice during intrapartum prophylaxis, for the prevention of neonatal disease caused by GBS in our region. The importance of epidemiological surveillance of sensitivity to penicillin and other antimicrobials is highlighted in order to alert new resistance mechanisms and to adapt treatment strategies.

Os medicamentos estão fortemente relacionados com o quotidiano e a vida privada. As doenças infeciosas constituem uma área da história da medicina onde se cruzam problemas de higiene pública e de higiene privada. As medidas a tomar para atacar o problema podem ser medidas sociais ou terapêuticas medicamentosas. Nas duas primeiras partes do artigo, tomam-se como base obras de referência de terapêutica medicamentosa e de higiene da primeira metade do século XX: as Licções de Pharmacologia e Therapeutica Geraes de E. Motta, o tratado Bases de Terapêutica Medicamentosa, de P. Trendelenburg, o Manual de Hygiene, de A. J. Lopes, Livro de Higiene de A. Lessa e Como é a vida e como se defende de F. Mira. Avaliam-se os medicamentos utilizados no combate a doenças infeciosas declaradamente relacionadas com a vida privada e o modo como esses medicamentos eram considerados, especialmente os compostos arsenicais e mercuriais. A terceira parte incide sobre a introdução da penicilina na terapêutica medicamentosa entre 1944 e 1945, tomando como fontes a literatura científica portuguesa. Analisam-se as principais inovações e vantagens que este fármaco trouxe para muitas doenças infeciosas com implicações na vida privada.

Antibiotics have selective toxicity against bacteria. This is possible because these drugs bind to certain protein and inhibit their activity, proteins that exist only at the level of bacteria and not at the level of the macroorganism, and on the other hand, these structures are of vital importance for the bacteria. Being of protein nature, these structures are genetically determined. This makes an antibiotic effective only against bacteria that have such genes, the other bacteria being resistant to the antibiotic. This type of bacterial resistance to antibiotics is called natural resistance. But there is also an acquired resistance of bacteria to antibiotic that refers to the fact that some bacteria were initially sensitive or even very sensitive to a particular antibiotic, but later developed resistant strains. The acquired resistance is also genetically coded and occurs through genetic mutations. When the resistance- encoding gene is located at the chromosome level, we talk about chromosomal resistance, and when it is located outside the chromosomes, extracromosomal resistance is discussed. Chromosomal resistance is transmitted only within the same bacterial strain and disappears with the disappearance of that strain. Extracromosomial resistance can also be transmitted between bacteria belonging to different strains or species. Microbial resistance to antibiotics is more common when the antibiotic is older and more commonly used. This makes the antibiotic resistance of microbes vary from one geographic area to another. Generally, in rural areas there are fewer strains of resistant microbes to antibiotic than in urban environments. Most resistant strains are found in the hospital environment where many antibiotics are used. There are also antibiotic resistance differences between different countries depending on how antibiotics were used in each country. The most effective way to preserve the efficacy of antibiotics in the treatment of infectious diseases is a national policy of rational use of antibiotics. [ABSTRACT FROM AUTHOR]

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Objectives: To confirm the presence of allergy to penicillin and amoxicillin by in vivo exposure tests in patients with a history of immediate reaction to these drugs. Methods: Observational, cross-sectional, descriptive and prolective study. Patients between 12 and 60 years old with a history of immediate reaction after administration of penicillin and/or amoxicillin were included. Skin prick and intradermal tests were performed with benzylpenicilloyl polylysine and penicillin G, as well as oral challenge with amoxicillin. Results: Ten female and 3 male patients were included. The mean age was 39 years. In 84.6% of the cases the last adverse drug reaction occurred 10 years ago and in all cases it manifested with urticaria. Allergy to penicillin was corroborated in only 38.4% of cases. The most frequent adverse reaction after in vivo exposure tests was pruritus in 23%. Conclusions: Patients with suspected penicillin allergy should be evaluated by in vivo exposure testing with major and minor determinants to corroborate or rule out allergic reactions and improve treatment conditions. [ABSTRACT FROM AUTHOR]

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Antibiotics, in the broad sense of the word, are drugs that exhibit selective toxicity to certain bacteria. Because of this property, only bacteria can become resistant to antibiotics, not the macroorganism. Although they have selective toxicity against bacteria, antibiotics can also produce side effects in the macroorganism. In general, each antibiotic has certain target organs of its toxicity. There is no antibiotic that is toxic to all organs. The most typical adverse reactions of antibiotics are dysmicrobisms, which occur especially when taking broad-spectrum antibiotics, orally. For an antibiotic to be effective in the treatment of an infectious disease, it is necessary that the diseasecausing microbe is susceptible to the antibiotic, and that antibiotic penetrates and produces active concentrations at the site of the infection. To avoid systemic adverse reactions, it is important that the target organs of antibiotic toxicity not to be already ill to the patient. In order to avoid dysmicrobrobisms, a narrow spectrum antibiotic is preferred. With some notorious exceptions, the prophylactic antibiotic treatment is not recommended. [ABSTRACT FROM AUTHOR]

A importação regular de penicilina para Portugal iniciou-se em Setembro de 1944 através da Cruz Vermelha Portuguesa. Até Junho de 1945 a importação e distribuição do medicamento foram controladas por esta instituição humanitária mas a partir desta data, com o aumento da produção mundial, a penicilina começou a ser importada por intermédio da indústria farmacêutica. No Arquivo da Universidade de Coimbra consultamos papeletas (processos individuais) de doentes internados nos Hospitais da Universidade de Coimbra desde Setembro de 1944 até Agosto de 1946. A investigação realizada permitiu-nos recolher informações sobre a introdução da penicilina e sobre os primeiros tratamentos efetuados com o medicamento nestes hospitais. Com base nos dados recolhidos pretendemos, pelo presente artigo, mostrar como foi feita a receção da penicilina num hospital central de grande dimensão, um dos principais hospitais portugueses, saber a frequência com que era prescrita, as patologias mais comuns em que era empregue, as doses administradas, a posologia e o tempo de tratamento assim como os clínicos responsáveis pela sua prescrição.

Entre 1946 e 1948, o Serviço de Saúde Pública dos Estados Unidos (PHS) e a Oficina Sanitária Panamericana, com a colaboração de funcionários de saúde pública do governo da Guatemala, realizaram um estudo sobre o uso da penicilina como possível profilaxia para a sífilis, gonorreia e cancro. Os "sujeitos" do estudo - prisioneiros, doentes mentais e soldados gualtematecos foram inoculados com essas doenças e também pelo contato com prostitutas infectadas. A fraude foi parte do estudo e os abusos éticos foram discutidos no PHS. Os resultados do estudo não foram publicados.

The penicillin allergy skin testing is the only accurate and reliable test for penicillin hypersensitivity mediated by IgE. It is useful for identifying patients with doubtful history of allergy. Positive test for major and minor determinants presents a positive predictive value of 50% and negative predictive value of 99%. In Brazil, the Ministry of Health suggests a protocol for in house made reagents, since they are not commercially available. As the referred protocol does not mention some important details about the test procedures, we propose in the present work to implement them, critically evaluating each step in order to allow the protocol establishment at any health service, with quality and safety.O teste cutâneo para alergia imediata a penicilina é o único teste validado internacionalmente, sendo que sua grande utilidade reside na avaliação de pacientes com história positiva de alergia a penicilina. O teste positivo para determinantes principais e secundários da penicilina apresenta um valor preditivo positivo de 50% e valor preditivo negativo de 99%. Em nosso meio, o Ministério de Saúde disponibiliza um protocolo para o preparo dos reagentes, uma vez que os mesmos não estão disponíveis comercialmente. Como o referido protocolo não apresenta maiores detalhes sobre o cuidado relativo às etapas de preparo das soluções, bem como faltam algumas considerações no que tange a realização do teste, propusemo-nos no presente trabalho operacionalizar o teste, avaliando de forma crítica e minuciosa cada etapa, de forma que outros profissionais possam reproduzi-lo de maneira mais segura e eficaz.

Los porcentajes de resistencia a penicilina entre los estreptococos del grupo viridans han llegado a niveles superiores al 60% en algunos estudios realizados en la década pasada, y en recientes trabajos se los encontró asociados a un mayor índice de mortalidad en las bacteriemias. Aún no se conoce cuál es el nivel de concentración inhibitoria mínima de penicilina para el cual resulta imposible lograr un efecto sinérgico con algún aminoglucósido. Con este propósito, se estudió la sensibilidad a penicilina de 28 cepas de estreptococos del grupo viridans aisladas de materiales clínicamente significativos en el Hospital de Pediatría "Prof. Dr. Juan P. Garrahan". Se seleccionaron siete aislamientos pertenecientes al grupo mitis con distintas características de sensibilidad, y con ellos se ensayó la curva de muerte frente a penicilina, gentamicina y penicilina más gentamicina, con concentraciones de penicilina por encima y por debajo de su concentración inhibitoria mínima. En ningún caso se observó sinergia cuando la concentración de penicilina fue inferior a la concentración inhibitoria mínima, al menos en este grupo particular de estreptococos que presentaron concentraciones inhibitorias mínimas de gentamicina ³ 16 µg/ml. Se encontró sinergia en cinco de las siete cepas cuando se trabajó con concentraciones de penicilina superiores a la concentración inhibitoria mínima. En las otras dos, se detectaron enzimas modificadoras de aminoglucósidos.Penicillin resistance rates higher than 60% have been recorded in viridans group streptococci by some authors during the 90's and recently such resistance was associated with higher levels of mortality in bacteremia. The lowest minimal inhibitory concentration of penicillin for which synergy with aminoglycosides is not yet possible is still unknown. In order to try to dilucidate this puzzle, a study on the susceptibility to penicillin of 28 strains of viridans group streptococci isolated from significant samples in the Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" was carried out. Seven mitis group isolates presenting different susceptibility patterns were selected for performing time-killing curves with penicillin, gentamicin, and penicillin plus gentamicin, using higher and lower penicillin concentrations than their minimal inhibitory concentrations. Synergy was not observed when the penicillin concentration was lower than the minimal inhibitory concentration, at least in these strains with minimal inhibitory concentrations of gentamicin ³ 16 µg/ml. When using penicillin in higher concentrations than the minimal inhibitory concentration, synergy was found in five of the seven strains. Aminoglycoside-modifying enzymes were found in the two other streptococci.

El nombre sífilis proviene del griego siph: cerdo y philus: amor. Recuerda al personaje de una obra, llamado Syphilo, que fue castigado por los dioses a sufrir una terrible enfermedad. Se analizan los datos sobre la sífilis en la antigüedad (que difieren según su fuente). Su mención en la Edad Media, su controversial origen, la ayuda de los paleopatólogos para encontrarlo. Luego de la Revolución Francesa y el inicio de la Edad Contemporánea, el porcentaje de enfermos fue creciendo y se acentuó la segregación de los mismos por la sociedad. Desde el año 1500 hasta principios del siglo XX el tratamiento de la sífilis dependía del mercurio. Tenía una gran variedad de formas de aplicación. La vía tópica: el ungüento gris, en calomelano o tabletas, en inyecciones, en fricciones y fumigaciones en donde el mercurio se introducía en el cuerpo por lo pulmones. Se adjudicó a la madera del guayaco pretendidas características curativas, que no poseía. Los ioduros se utilizaron para el terciarismo. Ehrlich en 1907, patentó el compuesto 606 o Salvarsan y en 1910, el Neo-Salvarsan o Arsfenamina (compuesto 914). Por estos descubrimientos recibió el Premio Nobel. En 1887, Julios Wagner Jauregg sugirió que la fiebre terapéuticamente inducida era útil en el tratamiento de enfermos psicóticos. En 1912 publicó sus satisfactorios resultados al tratar la paresias con una combinación de mercurio-iodo y tuberculina de Koch. En 1917 ingresó a su servicio un enfermo de malaria, con cuya sangre escarificaron la piel palúdica de tres paréticos, en lugar de darle inmediatamente quinina. Por ello fue galardona con el Premio Nobel. Se utilizó luego el bismuto, a partir de 1922, pero posteriormente fue sustituido por las sulfamidas, de aplicación dificultosa. El avance terapéutico más importante ocurrió en 1943, año en que se comenzó a utilizar la penicilina por Mahoney y colaboradores. Luego se confirmó la eficacia de la tetraciclina para los alérgicos a la penicilina. Últimamente se confirmó la eficacia de la azitromicina en dosis de 500mg cada día, durante los 10 días o el régimen de 500mg en días alternos.The name Syphilis comes from greek language: Siph: Pig and Philus: Love, meaning, in honor of the Sheppard of a story where the Character, Named Syphilo, is punished by the gods to suffer a terrible disease. Data about Syphilis was analized in ancient times (which differ according to the source). Its mention in the middle age, its controversial origin, the help provided from paleopathologists to find it. When the French revolution and the beginning of the contemporary age began, the percentage of sick people grew. The segregation of these is proved by the society. From the year 1500 to the beginnings of the XX century, the treatment of Syphilis depended on mercury. There were a great variety of application methods: topical: the grey ointment, in «calomelanos or tabs», in injections, in frictions and fumigations where the mercury was introduced in the body by the lungs. Guayacos wood was named with curative features which it did not posses. The iodides were used for tertiary syphilis. In 1907, Ehrlich formulates the 606 compound or Salvarsan and in 1910 the Neo-Salvarsan or Arsfenamina or compound 914.Due to these discoveries he received the nobel prize. In 1887, Julius Wagner of Jauregg suggested that: the inducted therapeutic fiber was useful in the treatment of the psychosis. In 1912 he published his satisfactory results in treating the paresis with a combination of mercury and iodides and tuberculin of Koch. In 1917 he treated a patient who had malaria and instead of giving him immediately quinine, he made a scarification with his paludic blood the skin of 3 paretic patients. Because of this he was awarded with the nobel prize. Since 1922 bismuth was used, but then it was substituted by the sulphamidas of difficult application. The most important therapeutical advance happened in 1943, year in which penicillin was put in use by Mahoney and col. Later it was confirmed the efficiency of the tetracycline for the penicillin-allergic patients. Lately it has been confirmed the efficiency of the azithromizine in 500 mg dosis each day during 10 days or the regimen of 500 mg in alternate days.

Copyright of Revista ADM is the property of Asociacion Dental Mexicana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Asclepio is the property of Consejo Superior de Investigaciones Cientificas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJETIVO: A alta prevalência de anemia falciforme em nosso meio e a elevada morbimortalidade por infecções associada a esta condição estimularam a realização deste artigo de revisão. FONTE DE DADOS: Realizamos uma revisão bibliográfica no banco de dados MEDLINE no período de 1986 até 2003. Foram encontradas cerca de 600 referências sobre o tema, sendo selecionados 35 artigos, os quais, aliados a capítulos de dois livros-textos, compuseram esta revisão. SÍNTESE DOS DADOS: Neste artigo, além de informações gerais a respeito da doença falciforme, são abordados alguns tópicos sobre as infecções mais freqüentemente observadas no paciente com anemia falciforme, assim como a profilaxia medicamentosa e imunizações disponíveis. CONCLUSÕES: Esta é uma revisão que visa fornecer à comunidade pediátrica informações sobre o binômio anemia falciforme e infecções, a fim de minimizar suas complicações nesta comunidade específica.OBJECTIVE: To discuss the high prevalence of sickle cell disease in our environment and the increased morbidity and mortality as a result of infection associated with this condition. SOURCES OF DATA: Review of MEDLINE from 1986 to 2003. We found around 600 references about the subject. Thirty-five journal articles were reviewed, in addition to chapters in two text books. SUMMARY OF THE FINDINGS: We discuss general information concerning sickle cell disease as well as a few topics about the most frequently observed infections in these patients. Drug prophylaxis and immunizations are also covered. CONCLUSIONS: This review hopes to provide the pediatric community with information concerning the association between sickle cell disease and infections, so as to minimize the occurrence of complications.

En la década de 1920, Alexander Fleming descubrió, por casualidad, una sustancia que podía atacar a ciertas bacterias. Años más tarde, observó que colonias de la bacteria común Staphylococcus aureus eran eliminadas por un moho que había crecido en la misma placa Petri, determinando que este moho (Peni­cillium) elaboraba una sustancia, a la que llamó penicilina, que podía disolver las bacterias. Sus resultados se publicaron en 1929 [1] y se comenzó a utilizar en la práctica clínica en la década de los años 1940. Con la aparición de la penicilina se dio comienzo a la era de los antibióticos

El metabolismo de los antibióticos betalactámicos produce nuevos compuestos que unidos a proteínas plasmáticas pueden inducir, en una pequeña proporción de casos, una respuesta inmune nociva que en el 50% de los mismos está mediada por inmunoglobulina E (IgE). Los determinantes antigénicos mayores y menores de la penicilina son de gran utilidad en el diagnóstico in vivo de la alergia a este compuesto, con una sensibilidad de hasta un 70%, pero la detección in vitro de IgE específica tiene una menor sensibilidad que la prueba cutánea. Los cambios en la prescripción antibiótica han facilitado la aparición de individuos alérgicos a la ampicilina o la amoxicilina que toleran la penicilina G o V.

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Penicillin's trajectory towards becoming an effective antibacterial chemotherapeutic agent took place during World War II. Its strategic military value was immediately recognised by the Allies, and mass production was undertaken with the prime objective of meeting the needs of the armed forces. News of its development came to be widely reported on in the media and is examined here. These reports frequently combined accounts of penicillin's prodigious clinical effectiveness with the fact that it was to remain unavailable to the civilian population essentially until the war had ended. More penicillin was to be made available to the civilian population in the United States than in Britain, but the sense that it was severely rationed remained as high. It was in response to this that the idea of "homemade penicillin" was hatched. News of this was also widely promulgated by both the British and American media. Although the numbers treated with penicillin produced in this way was never to be significant, knowledge of the existence of such endeavours may have served to assuage in some measure the feelings of frustration felt by the civilian population at penicillin's non-availability. [ABSTRACT FROM AUTHOR]

El neumococo es un agente etiológico importante de infecciones comunes que afectan a todas las edades. En las últimas décadas han aparecido a nivel mundial cepas de neumococo resistentes a la penicilina. A nivel local no se conoce la magnitud de este problema. Objetivo: El objetivo fue determinar el porcentaje de resistencia del neumococo a la penicilina en portadores nasofaríngeos menores de 2 años en el Consultorio de Crecimiento y Desarrollo del Hospital Nacional Cayetano Heredia en Lima. Material y métodos: Se tomaron muestras de hisopeado nasofaríngeo en 170 niños (Setiembre 1996-Marzo 1997), para cultivo de neumococo y determinación de su sensibilidad a la penicilina con el E-test y a otros antibióticos con la sensibilidad en disco. Resultados: Se encontró 44% (75/170) de portadores nasofaríngeos de neumococo en niños de 6 meses a 2 años. La presencia de tres o más niños en la familia estuvo asociado a un mayor porcentaje de portadores. De las 75 cepas aisladas, 4 (5.3%) fueron resistentes a la penicilina, incluyendo 3 (4%) con resistencia intermedia y 1 (1.3%) con alta resistencia (MIC=1.5my g/mL). La resistencia a otros antibióticos fue: trimethoprim/ sulfamethoxazole 39 cepas (52%), cefaclor 18 (24%), cloranfenicol 17 (22.7%), eritromicina 14 (18.6%), clindamicina 9 (12%) y rifampicina 8 (10.7%). Conclusión: La resistencia del neumococo a la penicilina continúa baja en el Hospital Cayetano Heredia; sin embargo, es urgente establecer estrategias de prevención y control de la emergencia y diseminación de microorganismos resistentes. ( Rev Med Hered 1998; 9:56-62).

Acometimento do sistema nervoso central por actinomicetos é extremamente raro. Os autores descrevem um caso de actinomicose de cerebelo, com diagnóstico estabelecido após remoção cirúrgica da lesão e tratamento com sucesso com penicilina endovenosa e oral. Breve revisão da literatura sobre o envolvimento do sistema nervoso na actinomicose é apresentada.A 38 year-old man presented fever and a clinical picture of intracranial hypertension and ataxic syndrome. A CT-scan disclosed an expanding lesion of the cerebellum. Surgical excision of the lesion was performed and pathological examination made the diagnosis of an actinomycotic abscess. The probable primary source of infection were the lungs and/or oral cavity. The postoperative course was uneventful, with complete recovery after a long period of treatment with penicillin (IV and PO). The authors review some aspects about central nervous system involvement in actinomycosis.

Congenital syphilis is a remergering infection in Mexico and the world. We describe the case of a female infant with perinatal exposure to human immunodeficiency virus, early onset congenital syphilis with multisystem disease diagnosed by clinical history, skin manifestations and confirmed by immunohistochemistry and histopathology, which was successfully managed with penicillin. Prevention strategies should address reproductive health and prenatal care, reducing the rates of prematurity, fetal and neonatal mortality and irreversible consequences of this condition that remains a public health problem today. [ABSTRACT FROM AUTHOR]

Congenital syphilis remains a public health problem in the XXI century, secondary to the emergence of infection with human immunodeficiency virus, drug abuse during pregnancy, and limited access to health care in some communities, avoiding the timely diagnosis and treatment. The skin lesions in congenital syphilis occur in 60% of cases, often being key to the suspected diagnosis of this entity. Pediatricians and dermatologists should be familiar with these clinical features and alert to the possibility of congenital syphilis, especially in high-risk pregnant women and in those who received no prenatal care or it was late. Congenital syphilis is not only a preventable disease, its timely detection would decrease health care costs in developed and developing countries. This paper reviews the latest findings in the diagnosis and treatment of congenital syphilis as well as the panorama of the disease in Mexico. [ABSTRACT FROM AUTHOR]

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