Neurosyphilis in the patients with and without HIV infection. Description and comparison of two historical cohorts Neurosyphilis follows a more aggressive and different clinical course in HIV-infected patients compared to patients with normal immunity. Two historical series of patients with a diagnosis of neurosyphilis between 1995 and 2008 were compared: they included a group of 15 patients with y and 28 patients without HIV infection. Probability of neurosyphilis in patients with positive serum VDRL (+) was increased in patients infected with HIV comparedto HIV (-) negative patients (OR: 62.37 IC:95% (32.1-119.1) p value:< 0,001). Predominant clinical manifestations in neurosyphilis in the HIV (-) group were ocular abnormality, vascular encephalic and spinal cord lesions. In the HIV (+) positive group, they were fever, ocular abnormalities and headache. There were no differences in cerebrospinal fluid characteristics between both groups. Neurosyphilis was diagnosed even in patients with blood VDRL of < 1:32: 17,8% of HIV (+) and 60% of HIV (-) patients. Penicillin sodium at dose > than 18.000.000 IU/day IV during 14 days was the most common treatment. In patients with clinical neurosyphilis, 93% of HIV (-) group, and 54,2% of HIV (+) group had persistent neurological sequels. Three HIV (+) patients died due to causes not related to neurosyphilis.

Background: Influenza-A (IA) occurs every winter, is mostly observed among outpatients. Aim: To describe the clinical and epidemiological characteristics of cases that required hospital admission during an outbreak in Chile in 1999. Patients and methods: Adults subjects, with Influenza A confirmed by antigen detection test, hospitalized in the clinical hospital of the «Hospital Clínico de la Universidad Católica de Chile» between May and June, with fever or respiratory symptoms were studied. A special record was designed to register clinical, microbiological and therapeutic data. Results: Fifty five cases, 26 males, aged 15 to 91 years, were studied. Eighty four percent had chronic concomitant diseases and 9.1% were immunosuppressed. Clinical findings were fever in 87.3%, asthenia in 83.6%, cough in 93.6%, abnormal pulmonary signs in 69%, an elevated C-reactive protein (mean value of 11.6 ± 7.1 mg/dL) and acute respiratory insufficiency in 54.5%. Cases were isolated in cohort or individual rooms and 38.2% were admitted to intensive or intermediate care units. Amantadine was prescribed to 52 patients and was well tolerated. Thirty three percent of cases developed pneumonia. These subjects were older, had more dyspnea and respiratory insufficiency than patients without pneumonia. Conclusions: IA should be borne in mind when dealing with hospitalized adults, during epidemic outbreaks in the community. The clinical picture can resemble a serious bacterial infection. An early diagnosis allows the use of specific treatments, to decrease the risk of nosocomial spread and to avoid unnecessary use of antibiotics (Rev Méd Chile 2004; 132: 317-24). (

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Objectives:To establish the etiology of pneumonia and to compare the yield of diagnostic techniques for diagnosis of Pneumocystis jiroveci and Mycobacterium tuberculosis infections in HIV-1-infected patients. Patients and Methods: Subjects underwent sputum induction and bronchoalveolar lavage (BAL). Gram, Ziehl-Neelsen, silver stain (SS) and immunofl uorescense staining (IF) for P. jiroveci, fl uorescent stain for mycobacteria, PCR for P. jiroveci and M. tuberculosis, aerobic, fungal and mycobacterial cultures, respiratory viruses and CMV cultures were performed on the sputum and BAL. IgM for Mycoplasma pneumoniae and Chlamydophyla pneumoniae, and Legionella pneumophila urinary antigen were also obtained. Results: Sixty patients were included. An etiologic diagnosis was made in 97%. Pneumocystis jiroveci was the most frequent etiology (58%) followed by Streptococcus pneumoniae (12%), and Mycobacterium avium complex (12%). Mycobacterium tuberculosis was found in 5%. Conclusions:The comparison of diagnostic methods for P. jiroveci showed a higher sensitivity of IF and SS in BAL than in sputum, however PCR was equally sensitive in both samples. With this approach a precise etiologic diagnosis was reached in the great majority of patients. The most common etiology was P. jiroveci. IF in BAL remains the gold standard for diagnosis of P. jiroveci pneumonia.Key words: Pneumonia, Acquired Immunodefi ciency Syndrome, HIV, AIDS-Related Opportunistic Infections, Etiology.Palabras clave: Neumonía, síndrome de inmunodefi ciencia adquirida, VIH, infecciones oportunistas, etiología. Pontificia Universidad Católica de ChileDepartamento de Medicina Interna (CPC,MCA, JLL, MBM, PGG, GAL). Departamento de LaboratorioClínico (PGC). Departamento de EnfermedadesRespiratorias (TBW, RMB)Departamento de Pediatría (PVC). Programa de EnfermedadesInfecciosas (CPC, PGC, JLL, GAL). . El sistema respiratorio es un sitio donde frecuentemente se producen infecciones fúngicas (Pneumocystis jiroveci, anteriormente denominado Pneumocystis carinii), bacterianas y por micobacterias. La tasa de neumonía por P. jiroveci en los pacientes con recuentos de linfocitos CD4 ≤ a 200 céls/mm 3 , sin uso de profi laxis, es de 8,08 casos por 100 personas-año 2 . La neumonía bacteriana se presenta con una incidencia entre 2,3 y 10,8 episodios por 100 personas-año en los pacientes infectados por VIH (comparado con 0,9 por 100 personasaño en individuos sanos) 3,4 . La broncoscopia con lavado bronco-alveolar (LBA) se considera el método estándar para el diagnóstico etiológico de la neumonía en pacientes infectados por VIH. No obstante, puesto que es un método invasor, el esputo inducido aparece como una estrategia diagnóstica sensible y costo-efectiva. Las nuevas técnicas de diagnóstico molecular podrían disminuir la necesidad de procedimientos invasores para el diagnóstico etiológico de la neumonía en estos pacientes.El objetivo primario de este estudio fue establecer el diagnóstico etiológico de la neumonía en pacientes infectados por VIH utilizando métodos tradic...