Respiratory infections and bacteremia caused byNeisseria meningitidis serogroup W 2 , luego de haberse descrito en Europa, el año 2000, un aumento de los casos de EMI en relación a la peregrinación al "Hajj" en Arabia Saudita 3 . En los meses siguientes a la festividad musulmana ese año, se reportaron más de 400 casos en 16 países, demostrándose con posterioridad la clonalidad genética de una cepa hipervirulenta 4 . El serogrupo W se ha asociado en el mundo a prevalencias entre 1 y 8% del total de casos de EMI, con tasas bajas de portación. No obstante, la emergencia de clones hipervirulentos ha demostrado su capacidad para diseminarse y producir brotes epidémicos secundarios, afectando en Chile con mayores tasas de ataque y mayor letalidad a grupos etarios extremos 5 . Considerando la emergencia de este nuevo patógeno en Chile, nos parece relevante comunicar la experiencia reciente de tres pacientes adultos hospitalizados durante el 2013 en Clínica Alemana de Santiago. Los pacientes cursaron con meningococcemia por N. meningitidis serogrupo W y presentaron una infección respiratoria primaria seguida de rápido deterioro clínico, asociado a una intensa respuesta inflamatoria sistémica. Se trató de una mujer de 57 años con una epiglotitis aguda, un joven de 17 años con una neumonía condensante y un hombre adulto mayor de 91 años con Estudios previos han descrito asociaciones de los diferentes serogrupos con presentaciones más septicémicas y con menor compromiso menín-geo 6 . Series clínicas han señalado que las manifestaciones de la EMI por serogrupo W podrían tener algunas diferencias respecto de las provocadas por los serogrupos B y C, con menos invasión al SNC y mayor frecuencia de manifestaciones extra-meníngeas asociadas a la meningococcemia 7 . Asimismo, las infecciones respiratorias también han sido reportadas para los serogrupos W e Y como una presentación clínica de mayor frecuencia a diferencia de otros serogrupos 8 . No obstante, se plantea que el compromiso respiratorio podría verse favorecido por otra infección del tracto respiratorio que provoque las condiciones locales para una invasión de cepas de N. meningitidis colonizantes de la vía aérea 9 . Si este cambio de la epidemiología está afectando actualmente el espectro de manifestaciones clínicas de la EMI en Chile, es desconocido. Sin embargo, se hace necesario dilucidar esta interrogante con la perspectiva de mejorar el diagnóstico precoz en un escenario de incremento de la endemia, secundario a la introducción de un serogrupo emergente. La observación clínica de presentaciones atípicas en Chile donde el predominio del serogrupo W está impactando con una mayor letalidad a grupos etarios extremos (lactantes menores y adultos mayores), debe ser difundida. En este contexto, parece razonable considerar a la EMI dentro del diagnóstico diferencial de las sepsis severas de foco respiratorio.

We describe a case of chronic meningoencephalitis with hydrocephalus caused by Cryptococcus bacillisporus (VGIII) in an immunocompetent patient from Santa Cruz, Bolivia. This first report of a member of the Cryptococcus gattii species complex from Bolivia suggests that C. bacillisporus (VGIII) is present in this tropical region of the country and complements our epidemiological and clinical knowledge of this group of emerging fungal pathogens in South America.

Background Tele-education has emerged as an excellent alternative for traditional face-to-face education. It has allowed to connect first-world countries to developing countries for learning about low prevalent pathologies, such as tropical diseases, parasite infections, etc. Methods The Division of Infectious Diseases at University of Miami started an international videoconferencing program in 2018 in collaboration with 4 teaching sites (Miami, Peru, Chile, and Spain), in which 2 challenging cases were presented via Skype TM or Zoom TM. The cases were discussed by a partner institution member; all sites were invited to comment about the cases. After each conference, the medical students and physicians-in-training were asked to fill out a survey to evaluate their acceptance and perceptions towards this program. Results 54 participants completed the survey. 50% were residents or fellows, 18.5% were medical students, and 27.7% were visiting trainees. The overall acceptance was favorable, 64.9 % of participants reported that videoconferencing was as effective or more effective than face-to-face conferences, 96.3% wanted to continue participating in this program, and 87.04% would recommend it as an educational tool. Regarding the collaboration with international sites, 87% of participants felt they learned about diseases not commonly encountered in their countries, 85.2% considered that this program allowed them to learn about different treatment approaches, and 68.5% believed that it helped to learn about novel diagnostic tests. In terms of the content, 85.2% considered that the cases were interesting and 83.3 % believed that the cases were presented in an organized fashion. Regarding the software performance, 75.9 % believed that images were above average or outstanding, but only 48.1% felt the same about the audio. In terms of participation, 57.4% believed that interaction between the local audience and physicians from different sites was easily accomplished. Conclusion This videoconferencing program was widely accepted among trainees. The collaboration with international sites was perceived as one of the program assets. We believe that implementation of programs like this would be highly beneficial in Infectious Disease education. Disclosures Daniela De Lima, MD, Astra Zeneca: Stocks/Bonds|Pfizer: Stocks/Bonds.