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Se estudia 50 casos de pacientes que tuvieron parto prematuro. Se tuvo cuidado de no incluir aquellos casos en que la causa de prematuridad fue evidente (gemelares, polihidramnios, cuadros hemorrágicos). Se tomó muestra para cultivo de orina mediante cateterismo vesical en las primeras 48 horas postparto. Paralelamente se estudia 50 casos control de pacientes cuyo parto fue a término, e igualmente se efectuó urocultivo. Pudo obtenerse diferencias ostensibles en ambos grupos. En el grupo estudiado hubo 20% de urocultivos positivos, contra 10% del grupo control. El germen predominante fue E. Coli. La mortalidad perinatal en el grupo estudiado fue 20%, diez veces superior al grupo control. Se recomienda realizar rutinariamente urocultivos en todos los casos de amenaza de parto prematuro.

Introducción: Los microorganismos del género Arcobacter, considerados patógenos zoonóticos emergentes, son morfológicamente similares a Campylobacter. Los reportes de Arcobacter como agente etiológico de diarrea en humanos en América Latina son escasos. En el Perú no se ha comunicado su aislamiento en heces de humanos o en animales. Objetivos: Conocer la prevalencia de Arcobacter en heces de niños y adultos con/sin diarrea y en animales: aves, ganado vacuno, porcino, peces y mariscos. Diseño: Estudio descriptivo transversal. Institución: Instituto de Medicina Tropical Daniel A. Carrión, Universidad Nacional Mayor de San Marcos; Instituto Nacional de Salud del Niño; Instituto Materno Infantil de San Bartolomé; y Hospital Arzobispo Loayza, Lima, Perú. Material biológico: Aislamientos bacterianos de muestras de heces de humanos y animales. Intervenciones: Búsqueda activa de Arcobacter sp. en heces de humanos y animales, de julio a octubre del 2011. Principales medidas de resultados: Prevalencia de Arcobacter en heces. Resultados: Se encontró Arcobacter sp. en muestras de niños con diarrea (2/100), pero no sin diarrea (0/97); en 52 muestras de adultos con diarrea y 180 sin diarrea; solo se le aisló en una muestra correspondiente a una persona sin diarrea. Entre las especies animales, las especies con mayor prevalencia de Arcobacter sp fueron bovinos (25%) y porcinos (29,2%). Entre las especies marinas, las dos especies de mariscos estudiadas presentaron prevalencias altas: choro 24% (12/50) y langostinos 22% (11/50). Conclusiones: Arcobacter es un germen zoonótico, potencialmente patógeno para el ser humano, en particular para los niños. Debe ser estudiado sistemáticamente en especies animales utilizadas para el consumo humano. Así mismo, es importante realizar estudios relacionados con aspectos ecológicos, su comportamiento frente a los antimicrobianos y su transmisibilidad al ser humano. Introduction: Microorganisms of the genre Arcobacter considered emerging zoonotic pathogens are morphologically similar to Campylobacter. Reports of Arcobacteras as etiologic agent of diarrhea in humans in Latin America are scarce. In Peru its isolation in feces of humans or animals has not been reported. Objectives: To determine the prevalence of Arcobacter in feces of children and adults with/without diarrhea and in animals: birds, cattle, pigs, fish and seafood. Design: Cross-sectional study. Setting: Institute of Tropical Medicine Daniel A. Carrion, Universidad Nacional Mayor de San Marcos; National Institute of Child Health; Maternal and Child San Bartolome Institute; and Arzobispo Loayza Hospital. Biologic material: Bacterial isolates from stool samples of humans and animals. Interventions: Active search of Arcobacter sp. in human and animal feces, from July to October 2011. Main outcome measures: Prevalence of Arcobacter in feces. Results: Arcobacter sp. was found in samples from children with diarrhea (2/100), but not in those without diarrhea (0/97). In samples of adults with diarrhea (52) and without diarrhea (180), only one sample was isolated from a subject without diarrhea. Among animals, species with higher prevalence of Arcobacter sp were cattle (25%) and swine (29.2%). Among marine species, the two seafood species studied showed high prevalence: choro 24% (12/50) and prawns 22% (11/50). Conclusions: Arcobacter is a zoonotic germ potentially pathogenic to humans, particularly in children. Animal species used for human consumption should be studied systematically. It is important to perform studies on ecological aspects, behavior against antimicrobials and transmissibility to humans.

Objective To 1) describe the correlation between the zones of inhibition in 1-µg oxacillin disk diffusion (ODD) tests and penicillin and ceftriaxone minimum inhibitory concentrations (MICs) of meningeal and non-meningeal strains of Streptococcus pneumoniae and 2) evaluate the usefulness of the ODD test as a predictor of susceptibility to penicillin in S. pneumoniae and as a quick and cost-effective method easily implemented in a routine clinical laboratory setting. Methods S. pneumoniae isolates from healthy nasopharyngeal carriers less than 2 years old, obtained in a multicentric cross-sectional study conducted in various Peruvian hospitals and health centers from 2007 to 2009, were analyzed. Using Clinical and Laboratory Standards Institute (CLSI) breakpoints, the correlation between the zones of inhibition of the ODD test and the MICs of penicillin and ceftriaxone was determined. Results Of the 571 S. pneumoniae isolates, 314 (55%) showed resistance to penicillin (MIC ≥ 0.12 µg/mL) and 124 (21.7%) showed resistance to ceftriaxone (MIC ≥ 1 µg/mL). Comparison of the ODD test zones of inhibition and the penicillin MICs, using the CLSI meningeal breakpoints, showed good correlation (Cohen’s kappa coefficient = 0.8239). Conclusions There was good correlation between ODD zones of inhibition and penicillin meningeal breakpoints but weak correlation between the ODD results and non-meningeal breakpoints for both penicillin and ceftriaxone. Therefore, the ODD test appears to be a useful tool for predicting penicillin resistance in cases of meningeal strains of S. pneumoniae, particularly in low- and middle- income countries, where MIC determination is not routinely available.

Objetivo: Determinar los gérmenes más frecuentes causantes de infecciones en recién nacidos hospitalizados y la susceptibilidad antimicrobiana. Material y Métodos: Revisión de historias clínicas del Servicio de Neonatología del Instituto de Salud del Niño (Lima, Perú) y resultados de cultivos positivos y antibiogramas, desde junio de 1999 hasta mayo de 2002. Resultados: Durante el periodo de estudio hubo 94 pacientes con sepsis confirmada; de ellos se obtuvo 161 muestras (sangre, orina, catéteres EV, entre otras). Los gérmenes más frecuentes fueron: Staphylococcus epidermidis (38,3%), Staphylococcus aureus (12%), Klebsiella sp (10%), Alcaligenes fecalis (4,6%), Acinetobacter sp (4%) y Pseudomonas aeruginosa (4%). S. epidermidis mostró sensibilidad de 100% a vancomicina, 90% a cefotaxima, 50% a amikacina y ampicilina y 37% a oxacilina. Klebsiella mostró sensibilidad de 100% a ciprofloxacina e imipenen, 44% a ceftriaxona, 20% a ceftazidima y 14% a ampicilina; la resistencia a amikacina fue del 100%. S. aureus mostró sensibilidad de 100% a vancomicina, 57% a cefotaxima y 33% a oxacilina. Conclusiones: Las bacterias gram positivas son las más frecuentes como causa de sepsis neonatal. In vitro, los gérmenes más frecuentes muestran resistencia mayor de 50% a ampicilina y amikacina; y vancomicina es el antibiótico al cual muestran mayor susceptibilidad las especies de Staphylococcus. Objective: To determine the most frequent bacteria causing infection in hospitalized newborns, and their antimicrobial sensitivity. Material and Methods: Review of the clinical files of Neonatology Division, Children’s Health Institute (Lima, Peru) and identification of the positive cultures and antibiograms from June 1999 until May 2002. Results: During this three year period there were 94 patients with confirmed sepsis from whom 161 samples were obtained (blood, urine, IV catheters, and others ). The most frequently isolated bacteria were: Staphylococcus epidermidis (38,3%), Staphylococcus aureus (12%), Klebsiella sp (10%), Alcaligenes fecalis (4,6%), Acinetobacter sp (4%) and Pseudomonas aeruginosa (4%). S. epidermidis showed 100% sensitivity to vancomycin, 90% to cefotaxime, 50% to amikacin and ampicillin and 37% to oxacillin. Klebsiella showed 100% sensitivity to ciprofloxacin and imipenem, 44% to ceftriaxone, 20% to ceftazidime and 14% to ampicillin; bacterial resistance to amikacin was 100%. S. aureus showed 100% sensitivity to vancomycin, 57% to cefotaxime and 33% to oxacillin. Conclusions: Gram positive bacteria are the most frequent cause of neonatal sepsis. In vitro, 50% of the most frequent bacteria showed resistance to ampicillin and amikacin. The Staphylococcus species showed greater in vitro sensitivity to vancomycin.

Objective. To compare fecal screening tests in the diagnostic approach to childhood invasive diarrhea. Setting and patients. We assessed 125 consecutive children with acute diarrhea for fecal lactoferrin, fecal leukocytes and occult blood from November, 1995, to June, 1996. Results. Lactoferrin showed a greater overall sensitivity than fecal leukocytes or occult blood for detecting invasive pathogens. Combinations of lactoferrin or fecal leukocytes and of lactoferrin or occult blood or both yielded sensitivities and negative predictive values close to 100%, being superior to all other combinations. All patients with full breast-feeding and mixed feeding had a positive lactoferrin test with a 1:50 dilution used as the cutoff. In controls without diarrhea being exclusively bottle-fed, 3 of 15 (20%) still showed a positive lactoferrin result at the dilution of 1:50. This compared with 15 of 15 (100%) positive results among controls fully breast-fed, 14 of 15 (93%) among controls predominantly breast-fed and 11 of 15 (73%) among control children predominantly bottle-fed. Conclusions. This study confirms the usefulness of lactoferrin testing as a negative predictor. Breast-feeding lowers the specificity of the test but does not alter the sensitivity. Fecal lactoferrin may be viewed as the screening test of choice to avoid expensive stool cultures in the diagnostic approach to invasive diarrhea.

Staphylococcus aureus es un importante patógeno involucrado en una serie de infecciones e intoxicaciones, presenta múltiples factores de virulencia y su impacto se incrementa por su notable resistencia a los antimicrobianos. Objetivo: Determinar la frecuencia de Staphylococcus aureus meticilino resistente adquiridos en la comunidad, en hospitales de Lima- Perú. Material y métodos: Se realizó un estudio descriptivo multicéntrico. La resistencia a meticilina se determinó por el método Oxacillin Agar Screen. El origen de la cepa fue determinado mediante los criterios de los CDC; la Leucocidina de Panton Valentine fue identificada por métodos moleculares. Resultados: Se aislaron 276 cepas de Staphylococcus aureus, 160 fueron resistentes a meticilina (58%), 9 de ellas fueron identificadas como adquiridas en la comunidad (5,6%). La PVL fue identificada en 25 cepas (9,1%), 14 fueron MSSA y 11 MRSA, de éstas últimas solo 4 fueron MRSAcom, 7 fueron MRSAhosp (p

Lophomonas sp. is a habitual parasite of the intestinal tract of the cockroaches and that is not recognized as pathogenic human being. Nevertheless, in the world literature are few reports of Lophomonas sp. in respiratory tract secretions in patients with severe pulmonary disease, mostly in adults. We present evidences of Lophomonas sp. in the respiratory low tract of children attended in the national reference center of paediatric diseases of Lima, Peru, in the period 2009- 2010. We found six cases, 4/23 from broncoalveolar lavage and 2/794 from tracheal aspirate samples of children. Five of them had pneumonia and one atelectasis, four were hospitalized in the intensive care unit. Increase knowledge about the presence of this organism in respiratory infections is needed, as its real pathogenic role.

A case of an adult male patient diagnosed with HIV and Hepatitis C co infection is presented. He had granu-lomatuos hepatitis and blood smear positive to Paracoccidioides brasiliensis concomitant to the detection of MDR Mycobacterium tuberculosis in sputum further complicated with reactivation of cytomegalovirus (possible pancreatitis and retinitis). Difficulties in diagnostic and therapeutic approach in a patient with multiple infections are reviewed.

A case of an adult male patient diagnosed with HIV and Hepatitis C co infection is presented. He had granu-lomatuos hepatitis and blood smear positive to Paracoccidioides brasiliensis concomitant to the detection of MDR Mycobacterium tuberculosis in sputum further complicated with reactivation of cytomegalovirus (possible pancreatitis and retinitis). Difficulties in diagnostic and therapeutic approach in a patient with multiple infections are reviewed.

Human fascioliosis is one of the most important parasitic diseases in Peru, due to the high prevalence rates reported in the last few years, mainly in the Andean Trapeze. The most affected group is that of children and the clinical manifestations of the disease can be very varied. In this study we reported seven cases of human fascioliosis diagnosed in the Specialized Children's Health Institute (IESN) Lima, Peru, between 1988 and 2003. From 168 medical histories checked with the final diagnosis of parasitosis, 7 children (2 boys and 5 girls), between 2 and 14 years (average +/- DS: 8.52 +/- 1.43) were diagnosed with fascioliosis by a parasitic and/or serological examinations. Six of the seven cases came from cattle raising areas such as: Cajamarca, Ancash, Huancavelica and Junín. The most frequent clinical signs were prolonged fever (up to 42 days), hepatomegaly, moderate abdominal pain (right hypochondriac region and epigastrium), eosinophils count (between 132 and 8321/mmor =), anemia (hematocrit up to 15%), jaundice and hypergammaglobulinemia. In some cases the diagnosis was difficult to reach with a delay between 1 and 24 weeks. It should be pointed out that one of these patients had hepatic cirrhosis diagnosed by anatomopathological investigations. Finally, we propose that in pediatric patients coming from endemic areas of animal fasciolosis who have prolonged fever, abdominal pain and hepatomegaly, should be considered suspicious and the infection of eliminated, to avoid hepatic damage caused by this parasite. We conclude that human fascioliosis must not be under-estimated as a secondary parasitic disease in patients coming from endemic areas in Peru.

Se evaluó prospectivamente de mayo 1994 a junio 1995 la utilidad diagnóstica de nitrito, leucocitoesterasa y leucocituria para el diagnóstico de infección urinaria en 108 pacientes hospitalizados menores de 2 años de edad. Las muestras de orina fueron tomadas por punción suprapúbica. La prevalencia de infección urinaria fue de 10% (11 de 108 pacientes). La sensibilidad (S) y el valor predictivo negativo (VPN) fueron de 100% para leucocitoesterasa (criterio de positividad 10-25 leucocitos/ml) o para nitrito (criterio de positividad cualquier cambio de color). Sin embargo, la especificidad (E) y el valor predictivo positivo (VPP) fueron afectados sustancialmente con dichos umbrales de positividad. La S fue de 82 % y el VPP de 100% para leucocitoesterasa, con criterio de positividad 500/ml. Para nitrito, con criterio de positividad que excluyó los cambios de color débiles, S fue de 91 % y VPP de 43%. La especificidad y el valor predictivo negativo se mantuvieron cercanos a 100% para cualquiera de las pruebas con estos umbrales. La leucocituria tuvo, en general, bajo rendimiento comparada con las dos pruebas anteriores. La concordancia entre nitrito y leucocitoesterasa fuertemente positivos fue del 100%. Casi la mitad de los 11 pacientes con urocultivo positivo presentó anormalidades en la ecografía o en la cistouretrografía miccional. Se recomienda iniciar de inmediato el tratamiento de los pacientes cuando la orina tomada por punción suprapúbica resulte fuertemente positiva tanto para leucocitoesterasa como para nitrito. En los casos positivos para leucocitoesterasa solamente o para nitrito solamente, la decisión de iniciar tratamiento dependerá del juicio clínico. Debe realizarse sistemáticamente tanto ecografía renal como cistouretrografía miccional en lactantes y niños menores de 2 años con diagnóstico definido de infección urinaria., A prospective study was performed in 108 hospitalized children younger than 2 years old from May 1994 to June 1995. Urine specimens obtained through suprapubic aspiration were assessed for nitrite, leukocyte esterase and leukocyturia. Quantitative urine culture was the reference test employed. Prevalence of urinary tract infection was 10% (11 of 108 patients). Sensitivity and negative predictive values were 100% for leukocyte esterase (cut-point criterion 10-25 leukocytes/ul) or for nitrite these same thresholds were used. For leukocyte esterase with positivity criterion of 500 leukocytes/ul, sensitivity and positive predictive values were 82% and 100%, respectively. Nitrite with threshold excluding slight color changes yield sensitivity of 91% and positive predictive value of 43%. Both specificity and negative predictive values remained high for either nitrite or leukocyte esterase with same cut-points. Leukocyturia showed a lower performance as compared with either nitrite or leukocyte esterase. Concordance for both nitrite and leukocyte esterase results strongly positive was 100%. Overall, 5 out 11 patients revealed urinary tract abnormalities as assessed by ultrasonography or micturating cystourethrography. Prompt antimicrobial therapy is recommended when an urine specimen obtained by suprapublic aspiration yields both nitrite and leukocyte esterase results strongly positive. In cases with either leukocyte esterase or nitrite positive, the decision will rest upon clinical judgement. In addition, ultrasonography and micturating cystourethrography should be performed systematically in all children younger than 2 years old with a definite diagnosis of urinary tract infection.

Las observaciones microscópicas de los microorganismos, como bacterias, suelen hacerse con objetivos de mayor aumento y de inmersión. Las fotomicrografías con aquellos microscopios que tienen incorporada una cámara fotográfica, permiten usualmente visualizar los microorganismos en dos planos y las imágenes generalmente a 1000 aumentos. Éstas se encuentran principalmente en un atlas o como fotografías sueltas ilustrando manuales. Las imágenes a más de 1000 aumentos suelen requerir el uso de microscopios electrónicos de transmisión o de barrido (scanning). Con este último se obtiene imágenes tridimensionales, en muchos casos de gran ayuda para el mejor conocimiento de los microorganismos.

Objetivos: Identificar los serotipos de S. pneumoniae aislados, correlacionándolos con los incluidos en las vacunas existentes y su resistencia antimicrobiana. Diseño: Estudio descriptivo, observacional y longitudinal. Lugar: Instituto de Medicina Tropical Daniel A. Carrión, Facultad de Medicina, UNMSM. Material biológico: Cepas de Streptococcus pneumoniae. Intervenciones: Cuarenta Streptococcus pneumoniae de nuestro cepario, aislados entre el 2002 y 2006, fueron serotipificados en el Instituto de Salud Carlos III en Madrid -España; 15 fueron invasivos, 11 aislados de infecciones localizadas, 6 de portadores y 8 eran multiresistentes. Principales medidas de resultados: Protección de las vacunas existentes en nuestro medio a las infecciones causadas por Streptococcus pneumoniae. Resultados: Hubo 14 serotipos diferentes y los serogrupos más identificados fueron 23, 19 y 6. El 28,6% estaba contenido en la vacuna 7-valente, 42,9% en la 9-valente, 50% en la 11-valente y el 71,4% en la 23-valente; 57,5% fue resistente a la penicilina y 30% a eritromicina. El grupo de Streptococcus invasivo resultó más sensible a los antibióticos que los otros grupos. Los serotipos asociados a multirresistencia fueron 19F y 23F. Conclusiones: Ninguna de las vacunas protege a todas las infecciones causadas por Streptococcus pneumoniae, en nuestro medio. Objectives: To identify isolated S. pneumoniae serotypes correlating them with those covered by existing vaccines and determining antimicrobial resistance. Design: Descriptive, observational and longitudinal study. Setting: Daniel A Carrion Tropical Medicine Institute, School of Medicine, UNMSM. Biologic material: Streptococcus pneumoniae stocks. Interventions: Forty Streptococcus pneumoniae stocks isolated between 2002 and 2006 were serotyped at Carlos III Health Institute in Madrid, Spain; 15 were invasive, 11 isolated from localized infections, 6 from carriers and 8 were multiresistant. Main outcome measures: Protection of local existing vaccines to Streptococcus pneumoniae infections. Results: There were 14 different serotypes and most identified groups were 23, 19 and 6, 28,6% contained in the 7-valent vaccine, 42,9% in the 9-valent, 50% in the 11-valent and 71,4% in the 23-valent; 57,5% were resistant to penicillin and 30% to erythromycin. The invasive Streptococcus group proved to be more sensitive to antibiotics than the other groups; 19F and 23F serotypes were multiresistant. Conclusions: In our environment none of the studied vaccines protected all the infections caused by Streptococcus pneumoniae. Resistance to penicillin was high.

During the recent cholera epidemic which affected Peru and other Latin American countries, fresh stool samples of 100 hospitalized children were assessed February through April 1991. The children had been admitted because of profuse watery diarrhea. The microbiologic study of wet mount preparations showed curved bacteria suspicious for cholera agent and confirmed afterward to be Vibrio cholerae 01 scrotype Inaba. In 30% of such cases, besides the curved bacteria, a strikingly large number of trophozoites of Giardia intestinalis were observed. The same samples studied by permanent stains confirmed the presence of Giardia trophozoites. To our knowledge, the association of Giardia with serious epidemic cholera infection has not been previously described. All patients were admitted because of severe dehydration requiring intravenous fluid replacement, which might suggest a synergistic role for the above-noted coinfection. Adequately designed case-control studies are needed to ascertain the frequency and the pathophysiologic and clinical significance of such an unusual association.