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Vial PA, González C, Apablaza M, Vial C, Lavín ME, Araos R, Rubilar P, Icaza G, Florea A, Pérez C, Concha P, Bastías D, Errázuriz MP, Pérez R, Guzmán F, Olea A, Guzmán E, Correa J, Munita JM, Aguilera X. First wave of SARS-CoV-2 in Santiago Chile: Seroprevalence, asymptomatic infection and infection fatality rate. Epidemics 2022; 40:100606. [PMID: 35872438 PMCID: PMC9277990 DOI: 10.1016/j.epidem.2022.100606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/16/2022] [Accepted: 06/29/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The first wave of SARS-CoV-2 infection in Chile occurred during the cold season reaching a peak by the end of June 2020, with 80 % of the cases concentrated in its capital, Santiago. The main objective of this study was to estimate the attack rate during this first wave of SARS-CoV-2 in a large, densely populated city with more than seven million inhabitants. Since the number of confirmed cases provides biased information due to individuals' potential self-selection, mostly related to asymptomatic patients and testing access, we measured antibodies against SARS-CoV-2 to assess infection prevalence during the first wave in the city, as well as estimate asymptomatic cases, and infection fatality ratio. To our knowledge this is one of the few population-based cross-sectional serosurvey during the first wave in a highly affected emerging country. The challenges of pandemic response in urban settings in a capital city like Santiago, with heterogeneous subpopulations and high mobility through public transportation, highlight the necessity of more accurate information regarding the first waves of new emerging diseases. METHODS From April 24 to June 21, 2020, 1326 individuals were sampled from a long-standing panel of household representatives of Santiago. Immunochromatographic assays were used to detect IgM and IgG antibody isotypes. RESULTS Seroprevalence reached 6.79 % (95 %CI 5.58 %-8.26 %) in the first 107 days of the pandemic, without significant differences among sex and age groups; this figure indicates an attack rate 2.8 times higher than the one calculated with registered cases. It also changes the fatality rate estimates, from a 2.33 % case fatality rate reported by MOH to an estimated crude 1.00 % (CI95 % 0.97-1.03) infection fatality rate (adjusted for test performance 1.66 % [CI95 % 1.61-1.71]). Most seropositive were symptomatic (81,1 %). CONCLUSIONS Despite the high number of cases registered, mortality rates, and the stress produced over the health system, the vast majority of the people remained susceptible to potential new epidemic waves. We contribute to the understanding of the initial spread of emerging epidemic threats. Consequently, our results provide better information to design early strategies that counterattack new health challenges in urban contexts.
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Affiliation(s)
- Pablo A Vial
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Avenida Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile.
| | - Claudia González
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Av. Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| | - Mauricio Apablaza
- Facultad de Gobierno, Universidad del Desarrollo, Av. Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| | - Cecilia Vial
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Avenida Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| | - M Estela Lavín
- Facultad de Gobierno, Universidad del Desarrollo, Av. Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| | - Rafael Araos
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Avenida Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| | - Paola Rubilar
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Av. Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| | - Gloria Icaza
- Instituto de Matemática y Física, Universidad de Talca, Calle Dos norte #685, Talca 3465548, Chile
| | - Andrei Florea
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Avenida Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| | - Claudia Pérez
- Escuela de Enfermería, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Av. Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| | - Paula Concha
- Escuela de Enfermería, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Av. Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| | - Diego Bastías
- Escuela de Enfermería, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Av. Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| | - María Paz Errázuriz
- Escuela de Enfermería, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Av. Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| | - Ruth Pérez
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Avenida Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| | - Francisco Guzmán
- Facultad de Gobierno, Universidad del Desarrollo, Av. Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| | - Andrea Olea
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Av. Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| | - Eugenio Guzmán
- Facultad de Gobierno, Universidad del Desarrollo, Av. Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| | - Juan Correa
- Centro Producción del Espacio, Universidad de las Américas, Avenida Manuel Montt #948, Providencia, Santiago 7500975, Chile
| | - José Manuel Munita
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Avenida Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| | - Ximena Aguilera
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Av. Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
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Ezquer F, Quintanilla ME, Morales P, Santapau D, Munita JM, Moya-Flores F, Ezquer M, Herrera-Marschitz M, Israel Y. A dual treatment blocks alcohol binge-drinking relapse: Microbiota as a new player. Drug Alcohol Depend 2022; 236:109466. [PMID: 35489181 DOI: 10.1016/j.drugalcdep.2022.109466] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022]
Abstract
RATIONALE Gut microbiota communicates information to the brain. Some animals are born with a gut microbiota that predisposes to high alcohol consumption, and transplantation of fecal material from alcoholics to mice increases animal preference for ethanol. Alcohol-use-disorders are chronic conditions where relapse is the hallmark. A predictive animal model of relapse is the "alcohol deprivation effect" where ethanol re-access is allowed following chronic alcohol intake and a long alcohol deprivation. The present study evaluates the effect of gut microbiota modification on relapse, as an adjunct to N-acetylcysteine + Acetylsalicylic acid administration, which inhibits the alcohol-induced hyper-glutamatergic condition. METHODS Rats bred as heavy alcohol consumers (UChB) were allowed ethanol intake for one month, were deprived of alcohol for two-weeks and subsequently offered re-access to ethanol. Prior to ethanol re-access animals received orally either (i) vehicle-control, (ii) Lactobacillus-rhamnosus-GG after antibiotic treatment (LGG); (iii) N-acetylcysteine+Acetylsalicylic acid (NAC/ASA) or (iv) both treatments: LGG+ (NAC/ASA). RESULTS Marked binge drinking (1.75 g ethanol/kg in 60 min) and blood alcohol levels exceeding 80 mg/dl were observed in the control group upon ethanol-re-access. Lactobacillus-GG or (NAC+ASA) treatments inhibited alcohol intake by 66-80%. The combination of both treatments virtually suppressed (inhibition of 90%) the re-access binge-like drinking, showing additive effects. Treatment with NAC+ASA increased the levels of glutamate transporters xCT and GLT-1 in nucleus accumbens, while Lactobacillus-GG administration increased those of the dopamine transporter (DAT). CONCLUSIONS The administration of a well-accepted probiotic may be of value as an adjunct in the treatment of alcohol-use-disorders.
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Affiliation(s)
- Fernando Ezquer
- Center for Regenerative Medicine, Faculty of Medicine Clínica Alemana-Universidad del Desarrollo, Santiago, Chile; Research Center for the Development of Novel Therapeutic Alternatives for Alcohol Use Disorders, Santiago, Chile.
| | - María Elena Quintanilla
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Science, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Paola Morales
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Science, Faculty of Medicine, Universidad de Chile, Santiago, Chile; Department of Neuroscience, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Daniela Santapau
- Center for Regenerative Medicine, Faculty of Medicine Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - José Manuel Munita
- Genomics and Resistant Microbes Group, Faculty of Medicine Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Francisco Moya-Flores
- Genomics and Resistant Microbes Group, Faculty of Medicine Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Marcelo Ezquer
- Center for Regenerative Medicine, Faculty of Medicine Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Mario Herrera-Marschitz
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Science, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Yedy Israel
- Center for Regenerative Medicine, Faculty of Medicine Clínica Alemana-Universidad del Desarrollo, Santiago, Chile; Research Center for the Development of Novel Therapeutic Alternatives for Alcohol Use Disorders, Santiago, Chile; Molecular and Clinical Pharmacology Program, Institute of Biomedical Science, Faculty of Medicine, Universidad de Chile, Santiago, Chile.
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Olea A, Matute I, Hirmas M, González C, Iruretagoyena M, Munita JM, Pedroni E, Gómez MI, Nájera M. Respuesta inmunitaria al SARS-CoV-2 y factores asociados previo a la vacunación, en personal de salud de atención primaria en una comuna de Santiago, Chile. Rev Chilena Infectol 2022. [DOI: 10.4067/s0716-10182022000400382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ezquer F, Quintanilla ME, Moya‐Flores F, Morales P, Munita JM, Olivares B, Landskron G, Hermoso MA, Ezquer M, Herrera‐Marschitz M, Israel Y. Innate gut microbiota predisposes to high alcohol consumption. Addict Biol 2021; 26:e13018. [PMID: 33508889 DOI: 10.1111/adb.13018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/14/2020] [Accepted: 01/19/2021] [Indexed: 02/06/2023]
Abstract
Gut microbiota is known to be transferred from the mother to their offspring. This study determines whether the innate microbiota of rats selectively bred for generations as high alcohol drinkers play a role in their alcohol intake. Wistar-derived high-drinker UChB rats (intake 10-g ethanol/kg/day) administered nonabsorbable oral antibiotics before allowing access to alcohol, reducing their voluntary ethanol intake by 70%, an inhibition that remained after the antibiotic administration was discontinued. Oral administration of Lactobacillus rhamnosus Gorbach-Goldin (GG) induced the synthesis of FGF21, a vagal β-Klotho receptor agonist, and partially re-invoked a mechanism that reduces alcohol intake. The vagus nerve constitutes the main axis transferring gut microbiota information to the brain ("microbiota-gut-brain" axis). Bilateral vagotomy inhibited rat alcohol intake by 75%. Neither antibiotic treatment nor vagotomy affected total fluid intake. A microbiota-mediated marked inflammatory environment was observed in the gut of ethanol-naïve high-drinker rats, as gene expression of proinflammatory cytokines (TNF-α; IL-6; IL-1β) was significantly reduced by nonabsorbable antibiotic administration. Gut cytokines are known to activate the vagus nerve, while vagal activation induces pro-rewarding effects in nucleus accumbens. Both alcoholics and alcohol-preferring rats share a marked preference for sweet tastes-likely an evolutionary trait to seek sweet fermented fruits. Saccharin intake by UChB rats was inhibited by 75%-85% by vagotomy or oral antibiotic administration, despite saccharin-induced polydipsia. Overall, data indicate that the mechanisms that normally curtail heavy drinking are inhibited in alcohol-preferring animals and inform a gut microbiota origin. Whether it applies to other mammals and humans merits further investigation.
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Affiliation(s)
- Fernando Ezquer
- Center for Regenerative Medicine, School of Medicine Clínica Alemana‐Universidad del Desarrollo Santiago Chile
| | - Maria Elena Quintanilla
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine Universidad de Chile Santiago Chile
| | - Francisco Moya‐Flores
- Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB‐R) Santiago Chile
- Genomics and Resistant Microbes Group, School of Medicine Clínica Alemana‐Universidad del Desarrollo Santiago Chile
| | - Paola Morales
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine Universidad de Chile Santiago Chile
- Department of Neuroscience, School of Medicine Universidad de Chile Santiago Chile
| | - José Manuel Munita
- Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB‐R) Santiago Chile
- Genomics and Resistant Microbes Group, School of Medicine Clínica Alemana‐Universidad del Desarrollo Santiago Chile
| | - Belén Olivares
- Center for Medical Chemistry, School of Medicine Clínica Alemana‐Universidad del Desarrollo Santiago Chile
| | - Glauben Landskron
- Laboratory of Innate Immunity, Program of Immunology, Institute of Biomedical Science, Faculty of Medicine Universidad de Chile Santiago Chile
| | - Marcela A. Hermoso
- Laboratory of Innate Immunity, Program of Immunology, Institute of Biomedical Science, Faculty of Medicine Universidad de Chile Santiago Chile
| | - Marcelo Ezquer
- Center for Regenerative Medicine, School of Medicine Clínica Alemana‐Universidad del Desarrollo Santiago Chile
| | - Mario Herrera‐Marschitz
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine Universidad de Chile Santiago Chile
| | - Yedy Israel
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine Universidad de Chile Santiago Chile
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Porte L, Valdivieso F, Wilmes D, Gaete P, Díaz MC, Thompson L, Munita JM, Alliende R, Varela C, Rickerts V, Weitzel T. Laboratory exposure to Coccidioides: lessons learnt in a non-endemic country. J Hosp Infect 2019; 102:461-464. [PMID: 30885815 DOI: 10.1016/j.jhin.2019.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/11/2019] [Indexed: 01/27/2023]
Abstract
Coccidioides is a primary pathogenic fungus, which infects humans through highly infectious arthroconidia, causing substantial morbidity including life-threatening disseminated infections. Due to the low infectious dose, laboratory personnel might become infected during diagnostic procedures. Accordingly, coccidioidomycosis is reported as the most frequent laboratory-acquired systemic mycosis worldwide. This risk is aggravated in non-endemic countries, where the diagnosis may not be suspected. We report on an inadvertent exposure of 44 persons to Coccidioides posadasii in a clinical microbiology laboratory in Chile, the measures of containment after rapid diagnosis with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and the lessons learnt in a non-endemic setting.
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Affiliation(s)
- L Porte
- Laboratorio Clínico, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
| | - F Valdivieso
- Programa Medicina del Viajero, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; Laboratorio de Microbiología, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - D Wilmes
- Mycology Section, FG 16, Robert-Koch Institute, Berlin, Germany
| | - P Gaete
- Comite IAAS, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago
| | - M C Díaz
- Programa de Microbiologia y Micologia, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - L Thompson
- Servicio de Infectología, Departamento de Medicina Interna, Clínica Alemana, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - J M Munita
- Servicio de Infectología, Departamento de Medicina Interna, Clínica Alemana, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; Genómica & Resistencia Microbiana, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Chile; Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R)
| | - R Alliende
- Laboratorio Clínico, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - C Varela
- Laboratorio Clínico, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - V Rickerts
- Mycology Section, FG 16, Robert-Koch Institute, Berlin, Germany
| | - T Weitzel
- Laboratorio Clínico, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; Programa Medicina del Viajero, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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Noriega LM, Verdugo RJ, Araos R, Munita JM, Díaz V, Marcotti A, Perez J, Gonzalez P, Thompson L, Canals M, Hoppe A, Mounts AW, Vial PA. Pandemic influenza A (H1N1) 2009 with neurological manifestations, a case series. Influenza Other Respir Viruses 2010; 4:117-20. [PMID: 20409207 PMCID: PMC4941660 DOI: 10.1111/j.1750-2659.2010.00131.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Please cite this paper as: Noriega et al. (2010) Pandemic influenza a (H1N1) 2009 with neurological manifestations, a case series. Influenza and Other Respiratory Viruses 4(3), 117–120. Objectives Describe a series of atypical presentations of pandemic influenza A (H1N1) 2009. Methods Description of case series using hospital records. Results Six patients aged 1 to 65 years with confirmed pandemic influenza A (H1N1) 2009 infection presented with neurological complications within 2 to 5 days after the first signs of influenza‐like illness. All six were admitted with seizures or altered mental status. No abnormalities were found in brain scans or cerebral spinal fluid studies of any of the six. All were discharged without sequelae within days of admission. Conclusions This is only the second report of pandemic influenza presenting with neurological manifestations. Clinicians caring for patients when pandemic influenza is prevalent in their communities should maintain a high level of awareness of the potential atypical presentations with which this disease can appear.
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Affiliation(s)
- Luis Miguel Noriega
- Department of Medicine, Clínica Alemana de Santiago, Clínica Alemana School of Medicine, Universidad del Desarrollo, Santiago, Chile
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Noriega LM, González P, Hormazábal JC, Pinto C, Canals M, Munita JM, Thompson L, Marcotti A, Pérez J, Ibáñez D, Araya P, Canals C, Vial P. [Community acquired infections with methicillin resistant strains of Staphylococcus aureus: report of five cases]. Rev Med Chil 2008; 136:885-891. [PMID: 18949165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Community acquired infections with methicillin resistant strains of Staphylococcus aureus (MRSA) infections have a more aggressive clinical course and involve mostly skin and lungs. These infections appear as outbreaks among prisoners, sportsmen, men having sex with men and military personnel. The higher aggressiveness of these strains is due to the production of several toxins, mainly Panton- Valentine leukocidine. The detection of the gene that codes for this toxin is a distinctive feature of these strains. We report five patients with community acquired MRSA infections. The clinical presentation was a skin infection in all. One patient had a pleuropneumonia in addition. Apart for resistance to beta-lactam antimicrobials, the strains were resistant to erythromycin and ciprofloxacin. Patients were treated with vancomycin, clotrimoxazole or intravenous clindamycin with a good evolution. An epidemiological surveillance for community acquired MRSA strain infections should be started and measures to adequately treat infected patients and avoid dissemination should be implemented.
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Affiliation(s)
- Luis Miguel Noriega
- Unidad de Infectología y Departamento de Medicina, Clínica Alemana, Santiago, Chile.
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Noriega LM, González P, Hormazábal JC, Pinto C, Canals M, Munita JM, Thompson L, Marcotti A, Pérez J, Ibáñez D, Araya P, Canals C, Vial P. Staphylococcus aureus comunitario resistente a cloxacilina: Comunicación de los primeros cinco casos descritos en Chile. Rev Med Chil 2008. [DOI: 10.4067/s0034-98872008000700010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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