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An epidemic of dengue virus and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co-infections occurred in Argentina during 2020. We describe the clinical characteristics and outcomes in a cohort of patients hospitalized because of co-infection. We retrospectively identified 13 patients from different hospitals in Buenos Aires who had confirmed infection with SARS-CoV-2 and dengue virus and obtained clinical and laboratory data from clinical records. All patients had febrile disease when hospitalized. Headache was a common symptom. A total of 8 patients had respiratory symptoms, 5 had pneumonia, and 3 had rash. Nearly all patients had lymphopenia when hospitalized. No patients were admitted to an intensive care unit or died during follow up. Co-infection with SARS-CoV-2 and dengue virus can occur in patients living in areas in which both viruses are epidemic. The outcome of these patients did not seem to be worse than those having either SARS-CoV-2 or dengue infection alone.

The Argentine Society for Infectious Diseases and other national societies issued updated practical guidelines for the management of acute bronchitis (AB) and reactivations of chronic obstructive pulmonary disease (COPD) with the aim of promoting rational use of diagnostic and therapeutic resources. AB is a condition characterized by inflammation of the bronchial airways which affects adults and children without underlying pulmonary disease. It is usually caused by a virus. The diagnosis is based on clinical findings after community acquired pneumonia has been ruled out. Treatment of AB is mainly symptomatic. Antibiotics should be used in immune-compromised hosts, patients with chronic respiratory or cardiac diseases and in the elderly with co-morbidities. Reactivation of COPD is defined as an acute change in the patient's baseline clinical situation beyond normal day to day variations, with an increase in dyspnea, sputum production and/or sputum purulence, warranting a change in medication. An increase in one symptom is considered a mild exacerbation, two as moderate, and the presence of three symptoms is considered a severe exacerbation. An infectious agent can be isolated in sputum in 50 to 75% of COPD reactivations. Moderate and severe episodes must be treated with antibiotics, amoxicillin/ beta-lactamase inhibitor, macrolides and fluoroquinolones are first choice drugs.

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.

Brain abscesses by Propioni-bacterium acnes are rare. The rapid identification of this pathogen is important in order to choice the appropriate antibiotic therapy. We describe the case of a patient with excision of a multiform glioblastoma who 9 months later presented a tumor recurrence. A subtotal tumor excision was made and implants chemotherapy were placed in the residual tumor. After one month of surgery the patient presented a brain abscess. A craniotomy for drainage was performed. P. acnes was isolated from the biopsy and from purulent material. Identification was made by conventional biochemical tests and by the API system 20 A. The Minimum Inhibitory Concentration (MIC) to clindamycin, penicillin, amoxicillin and metronidazole was determined. The values of MIC (microg/ml) obtained were: 0.250, 0.040, 0.023 and 256, respectively. The patient received cefepime and metronidazole intravenously during 30 days and completed treatment with oral clindamycin for 60 days, considering the possibility of adjacent bone involvement. Eight months after the drainage the patient had no evidence of infection or tumor recurrence. Although P. acnes is a rare cause of post-neurosurgical infection, it should be considered as a possible pathogen in postoperative brain abscesses.

Introduction: Vancomycin-resistant enterococci isolates (VRE) have caused numerous outbreaks in intensive care units (ICUs). A contaminated hospital environment, the hands of health care workers (HCW), and carrier patients may play important roles in perpetuating the chain of transmission in these outbreaks. The aims of this study were to report the first VRE outbreak in our center and assess the role of environmental contamination and HCW hands in the spread of new cases of enterococcal infection., Material and Method: Between August and December 2003, surveillance cultures were performed with samples from all patients (n = 113) admitted to the ICU, as well as cultures of samples from the environment (n = 69) and HCW hands (n = 23)., Results: Eighteen clinical samples from 8 patients and 7 environmental samples yielded Enterococcus faecium (24 strains) and E. avium (1 strain). VRE was not detected on HCW hands. All the VRE isolates belonged to a single clone and carried the vanA gene., Conclusion: Environmental contamination provides an important reservoir for future outbreaks of VRE, perpetuating transmission of the microorganism in the hospital setting.