Daniel Pryluka

Mondelēz International (India)

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Gustavo Lopardo

Fundación Centro de Estudios Infectológicos

María José López Furst

Instituto de Efectividad Clínica y Sanitaria

Gabriel Levy Hara

El Hospital General de Agudos Carlos G. Durand

Pablo Scapellato

Hospital Donación Francisco Santojanni

Pablo Lapadula

Sanatorio Otamendi y Miroli

Diego Yahni

National Food Safety and Quality Service

M. Eugenia Socías

British Columbia Centre on Substance Use

Aníbal Calmaggi

Hospital Italiano La Plata

Analía Mykietiuk

Instituto Médico Platense

Martín E. Stryjewski

Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno

Cooperative Institutions

Instituto de Efectividad Clínica y Sanitaria

University of Buenos Aires

Johns Hopkins University

Sanatorio Otamendi y Miroli

Hospital Fernández

Fundación Huésped

Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno

Hospital Muñiz

Johns Hopkins Medicine

Fundación Centro de Estudios Infectológicos

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Experiencia COVID-19 en un sanatorio privado de Buenos Aires durante el primer mes de la pandemia: 26 casos

Medicina-buenos Aires (2020)

Pedro Wainer Federico Saavedra Valeria Tagliapietra Daiana Abeledo Daniela Migliore

El primer caso de infeccion por coronavirus (COVID-19) en Argentina se informo en Buenos Aires el 3 de marzo de 2020, en un paciente proveniente de Milan. El objetivo de este trabajo es describir las caracteristicas clinicas y curso de la enfermedad de una serie de pacientes infectados con COVID-19 en un sanatorio privado durante el mes de marzo del 2020. Durante marzo 2020 se internaron 63 pacientes sospechosos de infeccion por COVID-19. Fueron diagnosticados 26 positivos para COVID-19 por hisopado nasofaringeo, con el metodo RT-PCR para SARS Cov2. Se recopilaron datos sobre las caracteristicas epidemiologicas, signos y sintomas, asi como comorbilidades, laboratorio e imagenes. La edad promedio fue 40 anos (SD ± 15 anos); hubo un igual numero de varones; solo 1 caso no venia del exter ior. El sintoma mas frecuente fue la fiebre (24/26 casos) y la linfopenia (8/26). En un grupo (n = 17) la fiebre se limito dentro de las primeras 72 h y en otro, la fiebre duro 6 o mas dias (7 casos). Hubo un fallecido entre los 26 casos. La poblacion de nuestro estudio era joven y la mayoria de los casos fueron importados, en concordancia con el estadio de la epidemia en el momento en que el estudio fue realizado. Observamos que hubo 2 patrones en la curva termica pero la persistencia de la fiebre no implico un peor pronostico. Se necesitan estudios poblacionales mas grandes para confirmar estos hallazgos clinicos.

2019-20 coronavirus outbreak

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Update on Primary HIV-1 Resistance in Argentina

JAIDS Journal of Acquired Immune Deficiency Syndromes (2006)

Alejandro Petroni Gabriel Deluchi Daniel Pryluka Flavio Rotryng Raúl Bortolozzi

Here we present a survey including 52 drug-naive recently HIV-1-infected subjects from Buenos Aires City and province (79%) and 3 other regions in Argentina (21%). Recent infections were established from previous negative serology (32/52), indeterminate Western blot (12/52), or acute retroviral syndrome after high-risk HIV exposure (8/52) within 9 months before genotyping (median time, 4.2 months). Genotyping was performed from plasma by sequencing both protease and reverse transcriptase. Phylogenetic analysis combined with bootscanning resulted in 21 subtype B sequences and 31 B/F recombinants (RecBF). On protease, minor resistance-related mutations were found in both subtype B and RecBF with low frequencies. The substitution L89M, recently suggested as a resistance-related mutation in some subtype F viruses, was observed in 1 RecBF. On reverse transcriptase, major resistance-related mutations were found in 4 of 52 (7.7%) patients from different health centers: M41L (subtype B) and K103N+/-P225H (1 RecBF and 2 subtype B). The greater than 5% resistance threshold found indicates a need for sentinel resistance surveillances calling for an update in the current resistance testing guidelines in Argentina.

Resistance mutation

10.1097/01.qai.0000222285.44460.e2

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[Consensus guidelines for the management of upper respiratory tract infections].

PubMed (2012)

Gustavo Lopardo Aníbal Calmaggi Liliana Clara Gabriel Levy Hara Analía Mykietiuk

Upper respiratory tract infections are the most common source of antibiotic prescriptions. Acute pharyngitis is caused mainly by viruses, viral cases can be distinguished from acute streptococcal pharyngitis using Centor clinical epidemiological criteria, by rapid antigen tests or throat culture. Treatment of choice for streptococcal infection is penicillin V given in two daily doses. In children, acute otitis media (AOM) is the infection for which antibiotics are most often prescribed. Predominant causative pathogens include Streptococcus pneumoniae, Haemophilus influenzae non-type b and Moraxella catarrhalis. Diagnosis is based on history, physical examination and otoscopic exam. Antibiotic treatment should be initiated promptly in all children<2 years of age, and in older children presenting bilateral AOM, otorrhoea, co-morbidities or severe illness. In Argentina, amoxicillin is the drug of choice given the low penicillin resistance rates for S. pneumoniae. In children who fail amoxicillin therapy, amoxicillin/clavulanate provides better coverage against beta-lactamase producing H. influenzae and M. catarrhalis. Rhinosinusitis is caused mainly by viruses, secondary bacterial complication occurs in less than 5% of cases. Diagnosis is based on physical examination and additional studies are not usually required. Acute bacterial sinusitis is caused by the same pathogens that cause AOM and amoxicillin is the drug of choice.

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Declaración de Córdoba: hacia un mundo sin sida, el compromiso de América Latina

Pablo Bonvehí S. Cabrera Urbán Pedro Cahn Massimo Ghidinelli Horacio Jáuregui Rueda

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Rhodococcus equi as a cause of infective endocarditis: description of 2 clinical cases

Marie Françoise Tripodi Daniel E. Vigo Emanuele Durante‐Mangoni Pablo Kuschner Riccardo Utili

Rhodococcus equi

Infective Endocarditis

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Predicting mortality in hospitalized patients with 2009 H1N1 influenza pneumonia

The International Journal of Tuberculosis and Lung Disease (2011)

R. Riquelme Paula González‐Jiménez Alejandro J. Videla Heather P. Lopez James D. Chalmers

Community-acquired pneumonia (CAP) severity scores can identify patients at low risk for mortality who may be suitable for ambulatory care. Here, we follow the clinical course of hospitalized patients with CAP due to 2009 H1N1 influenza.To evaluate the role of CAP severity scores as predictors of mortality.This was a secondary data analysis of patients hospitalized with CAP due to 2009 H1N1 influenza confirmed by reverse transcriptase polymerase chain reaction enrolled in the CAPO (Community-Acquired Pneumonia Organization) international cohort study. CAP severity scores PSI (Pneumonia Severity Index), CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥ 65 years) and CRB-65 (confusion, respiratory rate, blood pressure, age ≥ 65 years) were calculated. Actual and predicted mortality rates were compared. A total of 37 predictor variables were evaluated to define those associated with mortality.Data from 250 patients with CAP due to 2009 H1N1 influenza were analyzed. Patients with low predicted mortality rates (0-1.5%) had actual mortality rates ranging from 2.6% to 17.5%. Obesity and wheezing were the only novel variables associated with mortality.The decision to hospitalize a patient with CAP due to 2009 H1N1 influenza should not be based on current CAP severity scores, as they underestimate mortality rates in a significant number of patients. Patients with obesity or wheezing should be considered at an increased risk for mortality.

Pneumonia severity index

10.5588/ijtld.10.0539

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[Argentine Intersociety Consensus on Urinary Infection 2018-2019 - Part II].

PubMed (2020)

Corina Nemirovsky María José López Furst Daniel Pryluka Lautaro De Vedia Pablo Scapellato

The second part of the Inter-Society Argentine Consensus on Urinary Tract Infection (UTI) includes the analysis of special situations. In patients with urinary catheter, urine culture should be requested only in the presence of UTI symptomatology, before instrumentation of the urinary tract, or as a post-transplant control. The antibiotics recommended for empirical treatment in patients without risk factors are third-generation cephalosporins or aminoglycosides. UTIs associated with stones are always considered complicated. In case of obstruction with urosepsis, an emergency drainage should be performed via a percutaneous nefrostomy or ureteral stenting. In patients with stents or ureteral prostheses, such as double J catheters, empirical treatment should be based on epidemiology, prior antibiotics, and clinical status. Before the extracorporeal lithotripsy procedure, bacteriuria should be investigated and antibiotic prophylaxis should be administered in case of positive result, according to the antibiogram. First generation cephalosporins or aminoglycosides are valid alternatives. The use of antibiotic prophylaxis with first-generation cephalosporins or aminoglycosides before percutaneous nephrolithotomy is recommended. Transrectal prostatic biopsy can be associated with infectious complications, such as UTI or acute prostatitis, mainly due to Escherichia coli or other enterobacteria. In patients without risk factors for multiresistant bacteria and negative urine culture, prophylaxis with intravenous amikacin or ceftriaxone is recommended. In patients with positive urine culture, prophylaxis will be performed according to the antibiogram, from 24 hours before to 24 hours post-procedure. For the targeted treatment of post-transrectal biopsy prostatitis, carbapenems for 3-4 weeks are the treatment of choice.La segunda parte del Consenso Argentino Intersociedades de Infección Urinaria incluye el análisis de situaciones especiales. En pacientes con sonda vesical se debe solicitar urocultivo solo cuando hay signo-sintomatología de infección del tracto urinario, antes de instrumentaciones de la vía urinaria o como control en pacientes post-trasplante renal. El tratamiento empírico recomendado en pacientes sin factores de riesgo es cefalosporinas de tercera generación o aminoglucósidos. Las infecciones del tracto urinario asociadas a cálculos son siempre consideradas complicadas. En caso de obstrucción con urosepsis, deberá realizarse drenaje de urgencia por vía percutánea o ureteral. En pacientes con stents o prótesis ureterales, como catéteres doble J, el tratamiento empírico deberá basarse en la epidemiología, los antibióticos previos y el estado clínico. Antes del procedimiento de litotricia extracorpórea se recomienda pesquisar la bacteriuria y, si es positiva, administrar profilaxis antibiótica según el antibiograma. Cefalosporinas de primera generación o aminoglúcosidos son opciones válidas. Se recomienda aplicar profilaxis antibiótica con cefalosporinas de primera generación o aminoglúcosidos antes de la nefrolitotomía percutánea. La biopsia prostática trans-rectal puede asociarse a complicaciones infecciosas, como infecciones del tracto urinario o prostatitis aguda, principalmente por Escherichia coli u otras enterobacterias. En pacientes sin factores de riesgo para gérmenes multirresistentes y urocultivo negativo se recomienda realizar profilaxis con amikacina o ceftriaxona endovenosas. En pacientes con urocultivo positivo, se realizará profilaxis según antibiograma, 24 horas previas a 24 horas post-procedimiento. Para el tratamiento dirigido de la prostatitis post-biopsia trans-rectal, los carbapenémicos durante 3-4 semanas son el tratamiento de elección.

Amikacin

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[Consenso Argentino Intersociedades de Infección Urinaria 2018-2019 - Parte I].

DOAJ (DOAJ: Directory of Open Access Journals) (2020)

Corina Nemirovsky María José López Furst Daniel Pryluka Lautaro De Vedia Pablo Scapellato

The Argentine Society of Infectious Diseases and other scientific societies have updated these recommendations based on data on urinary tract infections in adults obtained from a prospective multicenter study conducted in Argentina during 2016-2017. Asymptomatic bacteriuria should be treated only in pregnant women, who should also be systematically investigated; the antibiotics of choice are nitrofurantoin, amoxicillin, clavulanic/amoxicillin, cephalexin and trimethoprim-sulfamethoxazole. In procedures involving injury to the urinary tract with bleeding, it is recommended to request urine culture and, in the presence of bacteriuria, antimicrobial treatment according to sensitivity should be prescribed from immediately before up to 24 hours after the intervention. In women, cystitis can be treated with nitrofurantoin, cephalexin or fosfomycin, while trimethoprim-sulfamethoxazole and fluoroquinolones are not recommended; pyelonephritis can be treated with ciprofloxacin, cefixime or cephalexin in ambulatory women or ceftriaxone, cefazolin or amikacin in those who are hospitalized. In men, urinary tract infections are always considered complicated; nitrofurantoin or cephalexin are recommended for 7 days, alternatively fosfomycin should be given in a single dose. In men, ciprofloxacin, ceftriaxone or cefixime are suggested for pyelonephritis on ambulatory treatment whereas ceftriaxone or amikacin are recommended for hospitalized patients. Acute bacterial prostatitis can be treated with ceftriaxone or gentamicin. Fluoroquinolones were the choice treatment for chronic bacterial prostatitis until recently; they are no longer recommended due to the increasing resistance and recent concerns regarding the safety of these drugs; alternative antibiotics such as fosfomycin are to be considered.

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CONTROVERSIAS ACERCA DEL TEST VIH PARA TODOS

REVISTA ARGENTINA DE MEDICINA (2017)

H Catalano Hugo Milione Silvio Payaslián Pascual Valdéz Daniel Pryluka

El 12 de enero de 2017, el Ministerio de Salud de la Nacion Argentina publico en el Boletin Oficial la Resolucion 55 – E/2017 que dispone una serie de obligaciones y recomendaciones para los miembros de los equipos de salud con respecto a la realizacion del test del virus de inmunodeficiencia humana (VIH) y establece, entre otras cosas, la obligatoriedad de ofrecer el test en determinados casos y la no obligatoriedad de contar con una orden medica para acceder al testeo en el ambito publico de la Republica Argentina. De inicio, el analisis critico de la resolucion nos enfrenta a dos interrogantes centrales a responder: ?cual es la evidencia que sostiene las definiciones principales de la resolucion? Y ?cuales son los potenciales danos que conlleva la misma? Mas alla de los analisis y la falta de evidencias duras que avalen la practica, seguimos fortaleciendo el dialogo en el marco de las decisiones compartidas pero, a la vez, pensamos que hay que realizar un analisis detallado de las fortalezas, oportunidades, debilidades y amenazas del sistema, antes de emitir estas recomendaciones, ademas de brindar mas herramientas a los profesionales de la salud. Palabras clave. Test de VIH, prevencion, normativas, prevencion cuaternaria, morbilidad, mortalidad, metas de la Organizacion Mundial de Salud (OMS), conflictos de interes, antirretrovirales. CONTROVERSIES ABOUT HIV TEST FOR EVERYBODYAbstract On January 12, 2017, in Resolution 55 - E/2017 of the Official Gazette, the Ministry of Health of the Argentine Nation published a series of obligations and recommendations for members of healthcare teams regarding the performance of the test of human immunodeficiency virus (HIV). The publication establishes, inter alia, the obligation to offer the test in certain cases without requiring a doctor's order in the public level of the Argentine Republic. At the outset, a critical analysis of the resolution poses two central questions to answer: what is the evidence that supports the main definitions of the resolution? And what are the potential damages that it entails? Besides the analysis and the lack of material evidence supporting the practice, we continue to endorse the dialogue within the frame of shared decisions. However in turn we think that it must be carried out a detailed analysis of the strengths, opportunities, weaknesses and threats of the system before issuing these recommendations, in addition to providing more tools to healthcare professionals. Key words. HIV test, prevention, regulations, quaternary prevention, morbidity, mortality, aims of the World Health Organization (WHO), conflicts of interest, antiretroviral drugs.

Christian ministry

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CONSENSO SOBRE DIAGNÓSTICO Y TRATAMIENTO DE INFECCIONES DE VÍAS RESPIRATORIAS ALTAS

Gustavo Lopardo Aníbal Calmaggi Liliana Clara Gabriel Levy Hara Analía Mykietiuk

Palabras clave: faringitis, otitis media aguda, sinusitis Abstract Consensus guidelines for the management of upper respiratory tract infections. Upper respiratory tract infections are the most common source of antibiotic prescriptions. Acute pharyngitis is caused mainly by viruses, viral cases can be distinguished from acute streptococcal pharyngitis using Centor clinical epidemiological criteria, by rapid antigen tests or throat culture. Treatment of choice for streptococcal infection is penicillin V given in two daily doses. In children, acute otitis media (AOM) is the infection for which antibiotics are most often prescribed. Predominant causative pathogens include Streptococcus pneumoniae, Haemophilus influen- zae non-type b and Moraxella catarrhalis. Diagnosis is based on history, physical examination and otoscopic exam. Antibiotic treatment should be initiated promptly in all children < 2 years of age, and in older children presenting bilateral AOM, otorrhoea, co-morbidities or severe illness. In Argentina, amoxicillin is the drug of choice given the low penicillin resistance rates for S. pneumoniae. In children who fail amoxicillin therapy, amoxicillin/clavulanate provides better coverage against beta-lactamase producing H. influenzae and M. catarrhalis. Rhinosinusitis is caused mainly by viruses, secondary bacterial complication occurs in less than 5% of cases. Diagnosis is based on physical examination and additional studies are not usually required. Acute bacterial sinusitis is caused by the same pathogens that cause AOM and amoxicillin is the drug of choice.

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