RESUMO
Toxoplasmosis is a widely distributed zoonosis produced by the parasite T. gondii. In Chile the seroprevalence has been estimated between 20-37% in general population. Defined risk groups acquire or reactivate the infection by T. gondii in patients undergoing SOT and HSCT are: heart transplant or heart-lung with D (+) and R (-), allogeneic HSCT with R (+), HSCT with cord cells, GVHD, history of previous clinical toxoplasmosis and use of corticosteroids for prolonged periods or in high doses. Hand washing, hygiene in food handling and weekly post-transplant surveillance since day 15 post transplant for six months, are universally recommended. All patients with SOT and HSCT, regardless of risk, should receive prophylaxis with cotrimoxazole and require no another specific prophylaxis against T. gondii (A2). It is particularly important in high-risk patients who cannot receive cotrimoxazole prophylaxis establish specific alternative against T. gondii (B3).
Toxoplasmosis es una zoonosis ampliamente distribuida, producida por el parásito T. gondii. En Chile la seroprevalencia se ha estimado entre 20-37% en la población general. Se han deinido grupos de riesgo de adquirir o reactivar la infección por T. gondii en pacientes sometidos a TOS y a TPH: trasplante cardíaco o de corazón-pulmón con D (+) y R (-); TPH alogénico con R (+); TPH con células de cordón; EICH activa; antecedentes de toxoplasmosis clínica previa y uso de corticoesteroides por tiempo prolongado o en altas dosis. De manera universal son importantes el lavado de manos e higiene en manipulación de alimentos y el seguimiento periódico post-trasplante con RPC desde los 15 días, una vez por semana, durante seis meses. Todos los pacientes con TOS y TPH, independiente de su riesgo, deben recibir proilaxis universal con cotrimoxazol y no requieren otra proilaxis especíica contra T. gondii ( A2 ). Es particularmente importante que en los pacientes de alto riesgo que no puedan recibir cotrimoxazol, se establezca proilaxis alternativa especíica contra T. gondii (B3).
Assuntos
Adulto , Criança , Humanos , Anti-Infecciosos/uso terapêutico , Transplante de Órgãos , Complicações Pós-Operatórias/prevenção & controle , Transplante de Células-Tronco , Toxoplasmose/prevenção & controle , Esquema de Medicação , Incidência , Guias de Prática Clínica como Assunto , Fatores de Risco , Toxoplasmose/parasitologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
Chagas disease is a zoonosis caused by T. cruzi. The estimated prevalence in endemic areas is 0.6-0.9 / 100,000. In immunocompromised behaves as an opportunistic pathogen highly aggressive and can evolve with meningoencephalitis, myocarditis or systemic disease. We recommend obtaining serology for all donor and recipient of SOT and HSCT. An infected donor should be discarded as such. In the case of D (-) R (+) exists controversy between prophylaxis and pre emptive therapy. The chosen drug for prophylaxis is nifurtimox for 3 months, effective but with relevant adverse effects. Monitoring should be done with RPC and MicroStrout weekly until six months post-transplant, then on a monthly basis for the duration of immunosuppression and continued for life clinical monitoring (C3).
La enfermedad de Chagas es una zoonosis producida por T. cruzi. La prevalencia estimada en áreas endémicas es de 0,6-0,9/100.000 habitantes . En inmunocomprome-tidos se comporta como un patógeno oportunista de alta agresividad, pudiendo evolucionar con cuadros meningo-encefálicos, miocárdicos o sistémicos. Se recomienda obtener serología para todo donante y receptor de TOS y TPH. Un donante infectado se descarta como tal. En caso de D (-) R (+) existe controversia entre realizar proilaxis o vigilancia más terapia anticipada. La proilaxis aceptada es con nifurtimox por tres meses, efectiva pero con efectos adversos importantes. El seguimiento debe realizarse con RPC y MicroStrout semanal hasta los seis meses post-trasplante; luego, en forma mensual mientras dure la inmunosupresión y continuar de por vida la vigilancia clínica (C3).
Assuntos
Adulto , Criança , Humanos , Doença de Chagas/prevenção & controle , Nifurtimox/uso terapêutico , Transplante de Órgãos , Transplante de Células-Tronco , Tripanossomicidas/uso terapêutico , Doença de Chagas/parasitologia , Esquema de Medicação , Seguimentos , Nifurtimox/administração & dosagem , Complicações Pós-Operatórias , Guias de Prática Clínica como AssuntoRESUMO
Chagas disease is a zoonosis caused by T. cruzi. The estimated prevalence in endemic areas is 0.6-0.9 / 100,000. In immunocompromised behaves as an opportunistic pathogen highly aggressive and can evolve with meningoencephalitis, myocarditis or systemic disease. We recommend obtaining serology for all donor and recipient of SOT and HSCT. An infected donor should be discarded as such. In the case of D (-) R (+) exists controversy between prophylaxis and pre emptive therapy. The chosen drug for prophylaxis is nifurtimox for 3 months, effective but with relevant adverse effects. Monitoring should be done with RPC and MicroStrout weekly until six months post-transplant, then on a monthly basis for the duration of immunosuppression and continued for life clinical monitoring (C3).
Assuntos
Doença de Chagas/prevenção & controle , Nifurtimox/uso terapêutico , Transplante de Órgãos , Transplante de Células-Tronco , Tripanossomicidas/uso terapêutico , Adulto , Doença de Chagas/parasitologia , Criança , Esquema de Medicação , Seguimentos , Humanos , Nifurtimox/administração & dosagem , Complicações Pós-Operatórias , Guias de Prática Clínica como AssuntoRESUMO
Toxoplasmosis is a widely distributed zoonosis produced by the parasite T. gondii. In Chile the seroprevalence has been estimated between 20-37% in general population. Defined risk groups acquire or reactivate the infection by T. gondii in patients undergoing SOT and HSCT are: heart transplant or heart-lung with D (+) and R (-), allogeneic HSCT with R (+), HSCT with cord cells, GVHD, history of previous clinical toxoplasmosis and use of corticosteroids for prolonged periods or in high doses. Hand washing, hygiene in food handling and weekly post-transplant surveillance since day 15 post transplant for six months, are universally recommended. All patients with SOT and HSCT, regardless of risk, should receive prophylaxis with cotrimoxazole and require no another specific prophylaxis against T. gondii (A2). It is particularly important in high-risk patients who cannot receive cotrimoxazole prophylaxis establish specific alternative against T. gondii (B3).
Assuntos
Anti-Infecciosos/uso terapêutico , Transplante de Órgãos , Complicações Pós-Operatórias/prevenção & controle , Transplante de Células-Tronco , Toxoplasmose/prevenção & controle , Adulto , Criança , Esquema de Medicação , Humanos , Incidência , Guias de Prática Clínica como Assunto , Fatores de Risco , Toxoplasmose/parasitologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
Trypanosoma cruzi transplacental infection represents a serious public health concern in all the countries like Chile where recent success of insecticide spraying programs eliminated the vector. Because children infected with T. cruzi are usually asymptomatic, a study was designed including infected mothers and their children. The study was conducted for three years to establish diagnostic, treatment, and clinical observations variables. Mothers were tested for T. cruzi IgG, and the new born were examined for parasite DNA using PCR amplification. They were treated with nifurtimox and it was 100% effective, confirmed by successive PCR tests. It has been determined that there are 800 to 1000 new cases a year of transplacental Chagas' disease in Chile. This level of infection in the population should justify the establishment of a control and follow-up program for transplacental Chagas' disease.
Assuntos
Doença de Chagas/transmissão , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Complicações Parasitárias na Gravidez , Trypanosoma cruzi , Animais , Doença de Chagas/diagnóstico , Doença de Chagas/terapia , Pré-Escolar , Chile/epidemiologia , DNA de Protozoário , Feminino , Seguimentos , Humanos , Imunoglobulina G/sangue , Lactente , Recém-Nascido , Reação em Cadeia da Polimerase , Gravidez , Complicações Parasitárias na Gravidez/diagnóstico , Trypanosoma cruzi/isolamento & purificaçãoRESUMO
BACKGROUND: Human immunodeficiency virus (HIV) epidemiology has changed, affecting an increasing number of children. As in adults, the disease predominantly affects the digestive and respiratory systems. AIM: To report the gastrointestinal problems in HIV infected pediatric patients. PATIENTS AND METHODS: Twenty four HIV infected children (nine male, aged 1 to 12 years old, followed for 1 to 170 months), are reported. This group has been under care by a multiprofessional team. RESULTS: Oral candidiasis was present in 21 (88%), esophagic candidiasis in 3 (13%), oral ulcers in 4 (17%). Diarrhea was observed in 18 children (75%) and in eight, it had a chronic evolution. Cryptosporidium parvum was the most frequent agent found in six cases (1 with acute and 5 with chronic diarrhea). Schlerosing cholangiopathy was observed in one case, with a fatal outcome, in association to microsporidiosis. Upper endoscopy was done in 11 patients, demonstrating microscopic inflammatory changes in esophagic, gastric and duodenal epithelia in all. CONCLUSIONS: Digestive problems are common in HIV infected pediatric patients. They must be always sought actively. Endoscopy is a valuable tool for the early diagnosis of these problems.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/etiologia , Síndrome da Imunodeficiência Adquirida/complicações , Gastroenteropatias/etiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Criança , Pré-Escolar , Chile , Diarreia/diagnóstico , Diarreia/etiologia , Feminino , Seguimentos , Gastroenteropatias/diagnóstico , Infecções por HIV/complicações , Humanos , Lactente , Masculino , Doenças da Boca/diagnóstico , Doenças da Boca/etiologiaRESUMO
Con el objeto de evaluar las características clínicas, epidemiológicas y bioquímicas de esta infección en población infantil, se estudió a 55 niños infectados exclusivamente por Hymenolepis nana y que consultaron en forma consecutiva al Policlínico de Parasitología del Hospital Luis Calvo Mackenna. La edad promedio de ellos fue de 6 años 6 meses. A todos se les indicó una completa anamnesis, examen físico, examen coproparasitológico seriado de deposiciones, hemograma, carotinemia y proteinemia. Fueron tratados con niclosamida en dosis de 2g el 1- día y 1 g/día hasta completar 7 días de tratamiento, repitiéndose los controles y estudios ya enunciados al mes siguiente. Los síntomas más frecuentes resultaron dolor abdominal 74,5%, meteorismo 52,7%, diarrea crónica 49,1%, y falta de progreso ponderal en el 32,7%. El tratamiento fue efectivo sólo en el 74,5%de los niños. Las proteínas plasmáticas fueron normales en la totalidad de los casos infectados y un 20%presentó niveles de caroteno bajo 60 mg/dl las que se normalizaron una vez tratada la parasitosis. El 49%presentó eosinofilia que en promedio fue de 768 eosinófilos/ul. Los pacientes tratados subieron 1,4 kg en un lapso de 2 meses. Se destaca la importancia de la adecuada sospecha y tratamiento de esta parasitosis