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Invasive fungal disease (IFD) is a severe complication occurring mostly in haematooncological (H-O) patients and hematopoietic stem cell transplant (HSCT) receptors. Our aim was to describe the IFD occurring in our H-O and HSCT patients according to the EORTC/MSG revised criteria.IFD surveillance was performed in adult patients of the Hospital Clínico Universidad Catolica, Santiago, Chile, from January 2004 to January 2008.A total of 41 IFD episodes were identified in 39 patients; mean age was 46.6 +/- 9.9 years, and 87.8% and 12.2% occurred in H-O and HCTS patients respectively. 15/41(36.6%) episodes were proven, 36.6% probable and 11/41 (26.8%) possible. In 26 (63.4%) episodes aspergillosis was diagnosed (20 pulmonary, 3 sinus, 1 laryngeal and 1 case with pulmonary and cerebral involvement). In 7 patients (17.1%) candidiasis was diagnosed, 5 with a proven bloodstream infection and 2 with possible hepatosplenic candidiasis; mucormyeosis was diagnosed in 4 (9.8%) Fusarium infection was demonstrated in 2 patients (4.9%), and Mucor and Aspergillus pulmonary coinfection and Alternaria sp rhino-sinusitis in one patient each. The frequency of IFD among febrile neutropenic patients was 26.2% and 6.4% in H-O and HSCT receptors respectively. The overall mortality was 36%.Aspergillosis is the most common IFD infection among H-O patients and HSCT receptors in our center. Candidiasis followed although only in H-O patients most probably because of routine use of antifungal prophylaxis in HSCT recipients. Continuous surveillance is required to develop local guidelines and to evaluate antifungal strategies in different clinical scenarios.

The surveillance of febrile neutropenia (FN) episodes in every center allows adapt the antibiotic therapy guidelines to local epidemiology.To characterize clinical features and compare the FN etiology between hematological cancer (HC) and solid organ cancer (SOC) in our center.Surveillance study in adult patients with FN admitted to Hospital Clinico Universidad Católica, in Santiago, Chile, from January 2004 to August 2007.154 FN episodes corresponding to 87 patients were included. Mean age: 47 +/- 6 years-old; 71% had HC and 29% SOC. A clinical and/or microbiologically documented infection was recognized in 76%. Gastrointestinal 31.5%, upper respiratory 30.3% and lower respiratory 16.9% were the more frequent clinical focus. In 30.5% blood culture resulted positive: gram negative rods 51%, gram positive cocci 41% and yeasts 8%; being Escherichia coli 22%, S. coagulase negative (SCoN) 20% and Klebsiella pneumoniae 12% most frequent bacteria; 22.2% Enterobacteriaceae were ESBL producers and 55.6% 5CoN were methicillin resistant. In 18.3% of FN episodes the etiology was not established. Highest mortality was observed in episodes with microbiologically documented infection (14.5% vs 1.3%, p0.005). A clinical observed focus and positive blood cultures were more frequently obtamed among HC than SOC associated episodes: 37.3% vs 13.6%; (p0.01) and 67.2% vs 50%; (p = 0.045), respectively.The etiological profile of FN in our center and the necessity to continue the surveillance was described. Future studies are needed regarding risk factors of invasive infection that have worst prognosis.

Introduccion: La vigilancia de la etiologia de los episodios de neutropenia febril (NF) en cada centro permite adaptar guias de antibioterapia a la epidemiologia local. Objetivo: Caracterizar y comparar la etiologia de la NF en pacientes con cancer hematologico (CH) y de organos solidos (COS). Pacientes y Metodos: Estudio de vigilancia de NF de pacientes adultos en el Hospital Clinico Universidad Catolica, en Santiago, Chile, entre enero 2004 y agosto 2007. Resultados: 154 episodios de NF correspondientes a 87 pacientes: 47 ± 6 anos; 71% CH y 29% COS. Se documento infeccion clinica y/o microbiologicamente en 76%o. Mas frecuente fueron: foco gastrointestinal 31,5%, respiratorio alto 30,3%o y respiratorio bajo 16,9%o. En 30,5%o hubo hemocultivos positivos: bacilos gramne-gativos en 51%, cocaceas grampositivas en 41%, levaduras en 8%o; predominando: Escherichia coli 22%o, Staphylococcus coagulasa negativa (SCoN) 20%o y Klebsiella pneumoniae 12%; 22,2%o de las entero-bacterias eran productoras de (3-lactamasa de espectro expandido y 55,6%o >SCoN meticilina resistentes. En 18,3%o de los episodios no se identifico causa de fiebre. Hubo mayor mortalidad en episodios con documentacion microbiologica (14,5% vs 1,3%, p < 0,005). En los pacientes con CH fue mas frecuente obtener hemocultivos positivos (37,3%o vs 13,6%; p < 0,01) e identificar foco clinico (67,2% vs 50%; p = 0,045). Conclusiones: Se establece el perfil etiologico de las NF en nuestro centro y la necesidad de mantener vigilancia. En futuros estudios sera necesario evaluar factores de riesgo de pacientes con infecciones invasores que tendrian peor pronostico.

The diagnostic difficulties of brucellosis makes the evaluation of new diagnostic tests necessary.Evaluation of different commercial tests in the serological diagnosis of brucellosis by ELISA and immunocapture antibodies in a clinical series of patients with brucellosis of the Health Network of the Catholic University of Chile.All the serums received in the Laboratory of Microbiology for suspicion of brucellosis during five years were studied. Two groups were obtained, one that fulfilled diagnostic criteria for brucellosis [clinical evidence, and/or positive blood culture and/or seroagglutination test (SAT) in titers1/160] and the control group. Each serum sample was analyzed using irnmunocapture-agglutination test (Brucellacapt), ELISA IgM and IgG.Of 10 patients with brucellosis, the serologic results were: 8/10 positives for ELISA IgG, 7/10 for Brucellacapt and SAT, and 5/10 for ELISA IgM.ELISA IgG alone was superior than SAT. The combination ELISA IgG/ Brucellacapt reaches the best detection performance (9/10) and can be an alternative to SAT.

Introduccion: El diagnostico de brucelosis continua siendo complejo en la actualidad y se requieren nuevas pruebas de diagnostico. Objetivo: Evaluar pruebas comerciales para la determinacion serologica de anticuerpos anti Brucella sp mediante ELISA e inmunocaptura en una serie clinica de pacientes de la Red de Salud UC. Metodos: Estudio retrospectivo de pacientes cuyos sueros fueron recibidos en el laboratorio de Microbiologia para estudio serologico de brucelosis. Se obtuvieron 2 grupos, aquellos que cumplian criterios diagnosticos de brucelosis [cuadro clinico compatible, y/o hemocultivo positivo y/o serologia por seroaglutinacion en tubo (SAT) en titulos > 1/160] y el grupo control. Todos los sueros se analizaron mediante aglutinacion con inmunocaptura (Brucellacapt®), ELISA IgM y ELISA IgG. Resultados: De 10 pacientes con brucelosis, los resultados serologicos fueron: 8/10 positivos para ELISA IgG, 7/10 para Brucellacapt® y SAT y 5/10 para ELISA IgM. Discusion: ELISA IgG por si solo fue la mejor prueba para el diagnostico de brucelosis. La combinacion ELISA IgG+ Brucellacapt® alcanza un buen rendimiento de deteccion (9/10) y puede ser una alternativa a la SAT

Los cánceres de la cavidad nasal y de las cavidades paranasales (CPN) son neoplasias infrecuentes y de una gran variedad histológica. La complejidad de las estructuras vitales circundantes hacen que la cirugía radical y la radioterapia se asocien a complicaciones. Publicaciones recientes sobre el tema han demostrado una mejoría progresiva tanto de los métodos terapéuticos como de los resultados postratamiento. Repasamos los tipos de neoplasias que ocurren en las CPN y se discuten las opciones de tratamiento actuales, incluyendo las técnicas quirúrgicas y la terapia multimodal. Las neoplasias de CPN son complejas de tratar debido a las características anatómicas de la región y a la variedad de cánceres que ocurren en esta área. Actualmente el gold standard es la cirugía, abierta o endoscópica, combinada con radioterapia adyuvante. Las complicaciones potenciales incluyen cefalorraquia, meningitis, la formación de abscesos, ceguera, entre otros. Para mejorar la sobrevida de los pacientes con cáncer, debemos centrarnos en el diagnóstico precoz y preciso, así como en la búsqueda de tratamientos más eficaces, con los menores efectos adversos Cancers of the nasal cavity and paranasal sinuses are infrequent and of a great variety of histological types. The complexity of the surrounding vital structures render radical surgery and radiation therapy delicate and associated with numerous complications. Recent papers on nasal and paranasal sinuses carcinomas have shown a progressive improvement of treatments and results. Here we review paranasal sinuses tumor types and discuss current treatment options, including surgical techniques and polimodal therapy. Paranasal sinuses treatment is complex, because of the anatomic details of the region and the variety of cancers found in this area. At present, the gold standard is open or transnasal surgery, combined with adjuvant radiation therapy. Potential complications include cerebrospinal fluid leakage, meningitis, abscess formation and blindness, among others. in order to improve the survival of cancer patients, we should focus on early and accurate diagnosis as well as in the search for more effective treatments that minimize undesired side effects