Introduction: Xpert MTB/RIF Ultra has dramatically changed the diagnosis of tuberculosis. A new category called traces appeared, which is the smallest amount of bacillar load detectable. Objective: Describe the clinical characteristics of patients that present traces in Xpert MTB/RIF Ultra test, and to evaluate the confirmation of tuberculosis as clinical diagnosis. Methods: We perform a descriptive case series study. Information was recovered from clinical records of patients with positive test for traces. Clinical, histopathological and microbiological results were confronted. Results: Twenty one patients were analyzed. The mean age was 52 years-old. All cases had negative smear microscopy and four MGIT cultures were positive, two in pleural fluid and another in sputum. In parietal pleura, three cases presented granulomas with caseous necrosis, and one showed granuloma with very little necrosis. In pleural tissue we observed two cases of granulomas with traces of necrosis and two with non-necrotizing granulomas. Three patients had history of previous tuberculosis and positive traces, the test was interpreted as a false positive result. Finally, active tuberculosis was diagnosed in 13 cases, and five of them were pleural tuberculosis. The highest clinical, microbiological and histopathological agreement was in fluid and pleural tissue samples. Discussion: The findings of Xpert MTB/RIF Ultra in airway samples must be interpreted carefully. Multi-disciplinary analysis is crucial in future clinical decisions. The finding of traces in pleura has, in our opinion, a high diagnostic value in the study of tuberculosis in this location.

Resumen Introducción: El Xpert MTB/RIF Ultra (Ultra) ha mejorado dramáticamente el diagnóstico de la tuberculosis (TBC). Con él ha nacido la categoría de trazas, que es la menor carga bacilar detectable por este examen. Objetivo: Describir las características clínicas de los pacientes con presencia de trazas en el Ultra y evaluar la confirmación de la TBC como diagnóstico clínico. Materiales y Métodos: Estudio descriptivo de serie de casos. Se extrajo la información de fichas clínicas de pacientes con positividad a trazas. Se confrontaron datos clínicos, microbiológicos e histopatológicos. Resultados: Se analizaron 21 pacientes. La edad promedio fue de 52 años. Todos los casos presentaron baciloscopias negativas. Cuatro cultivos en medio líquido MGIT fueron positivos, dos en pleura parietal, uno en líquido pleural y otro en expectoración. En pleura parietal, tres casos presentaron granulomas con necrosis caseosa y un granuloma esbozos de necrosis. En tejido pulmonar se observaron dos casos con granulomas con esbozos de necrosis y dos con granulomas no necrotizantes. Tres pacientes tenían el antecedente de TBC previa, se interpretó la positividad de trazas en ellos como falsos positivos. Finalmente se diagnosticaron 13 casos como TBC activa, donde cinco de ellos fueron TBC pleurales. La mayor concordancia clínica, microbiológica e histopatológica fue en muestras de líquido y tejido pleural. Discusión: Se debe interpretar con cautela los hallazgos de esta prueba en muestras de vía aérea; el análisis multidisciplinario (clínica, imágenes, microbiología, histología) es crucial en las decisiones de nuestras conductas clínicas futuras. El hallazgo de trazas en pleura tiene, a nuestro parecer, un alto valor diagnóstico en el estudio de la tuberculosis en esta localización.

In vitro susceptibility of nosocomial and community acquired strains of Staphylococcus aureus must be periodically evaluated because of its continuous evolution. Aim: To know the antimicrobial susceptibility of S. aureus isolated in Valdivia, to determine the prevalence of methicillin resistance and global patterns of resistance and to compare the evolution of the susceptibility along the years. Material and Methods: A total of 278 S. aureus strains were evaluated: 136 obtained from hospitalized patients, 50 belonged to outpatients and 92 to healthy carriers. Antimicrobial agents tested were: penicillin, oxacillin, vancomycin, gentamycin, ciprofloxacin, lincomycin and erythromycin. Results: Thirty three, 28 and 1.1% of strains isolated from hospitalized, outpatients and carriers, respectively, were methicillin-resistant. Six resistance patterns were found. No vancomycin resistant strain was isolated. Comment: It is worrisome that 2% of S. aureus strains obtained from hospitalized patients showed intermediate resistance to vancomycin

La susceptibilidad in vitro de Staphylococcus aureus adquirido, tanto en el ambiente hospitalario como en la comunidad, debe ser monitorizada periódicamente por su continua evolución. Objetivos: Conocer la susceptibilidad antimicrobiana de cepas de S. aureus aisladas en Valdivia, determinar la prevalencia de cepas resistentes a meticilina y sus respectivos patrones de resistencia, analizar la evolución de esta susceptibilidad a través de los años. Material y Métodos: Se evaluaron 278 cepas de S. aureus: 136 obtenidas de pacientes hospitalizados, 50 de pacientes ambulatorios y 92 de portadores. Los antimicrobianos ensayados fueron: penicilina, oxacilina, vancomicina, gentamicina, ciprofloxacina, lincomicina y eritromicina

Background: Methicillin resistant strains of Staphylococcus aureus (MRSA) are an important cause of nosocomial infections. Aim: To determine the genotypes of MRSA strains. Material and methods: Fifty five strains of MRSA, isolated from patients hospitalized in Hospital Base Valdivia, were studied. The phenotype was determined through MicroScan® in all strains and by minimum inhibitory concentration (MIC) in 41. The genotype of the strains was analyzed by a duplex polymerase chain reaction (PCR) of the mecA gene, amplifying eight hypervariable DNA regions associated to such gene. Results: According to MIC, 88% of strains had a pattern of resistance against multiple antimicrobial (penicillin, ampicillin, cephradine, gentamycin, ciprofloxacin, ¡incomycin and erythromycin). Vancomicin resistan strains were not detected. Only 53 strains (96%) had at least one of the eight hypervariable regions and were classified as MRSA. Genotypic patterns types 15 were the most commonly detected in 38% and 34% of strains, respectively. MicroScan® erroneously classified five strains in an incorrect phenotype, according to results obtained with duplex PCR. MIC results did not differ from those of duplex PCR. Conclusions: Duplex- PCR is a useful tool to detect hyper variable regions associated to mecA gene

The susceptibility patterns of 50 A. butzleri strains to six antimicrobial agents were determined using the E-test method. No strain was found to be resistant to gentamicin and tetracycline, but two different strains (2%) were resistant to erythromycin and ciprofloxacin. Ninety and 98% of the strains were resistant to ampicillin and chloramphenicol, respectively. Only two of the 45 ampicillin resistant strains were able to produce ß-lactamase.

Se determinaron los patrones de susceptibilidad de 50 cepas de A. butzleri mediante el método del E-test. Ninguna cepa fue resistente a gentamicina y tetraciclina, pero, hubo cepas resistentes a eritromicina (2%) y ciprofloxacina (2%). Además, el 90 y el 98% de las cepas fueron resistentes a ampicilina y cloramfenicol respectivamente. Solamente dos de las 45 cepas ampicilina-resistentes fueron productoras de ß-lactamasa. Palabras clave: Arcobacter butzleri, susceptibilidad antimicrobiana, bacterias emergentes, E-test, ß-lactamasa

Campylobacter jejuni and C. coli are zoonotic agents of intestinal infection that could contaminate water bodies. Several outbreaks of Campylobacter gastroenteritis associated with the consumption of contaminated water have been reported. Various methods have been described to determine the presence of these bacteria in water bodies. In this study the performance of the Moore swab (MSM) and the filtration through membrane methods (MFM) for the isolation of Campylobacter from 181 water samples obtained from the urban course of the Calle-Calle river water samples was compared. Campylobacter species were isolated in 24.3% of the samples obtained with MSM and in 7.2% of those processed by MFM thus, appearing MSM as an efficient method to isolate Campylobacter from river water samples

Campylobacter jejuni y C. coli son agentes zoonóticos de infecciones intestinales que pueden contaminar cuerpos de agua. Varios brotes de gastroenteritis por Campylobacter asociados al consumo de agua han sido descritos. En este estudio se compara el rendimiento de los métodos de la tórula de Moore (MSM) y de filtración por membrana para el aislamiento de Campylobacter en 181 muestras de agua obtenidas del curso urbano del río Calle-Calle. En el 24.3% de las muestras obtenidas por MSM y en el 7.2% de las obtenidas por MFM fue posible aislar especies termotolerantes de Campylobacter, siendo C. coli aislado en mayor proporción que C. jejuni. Los resultados sugieren que MSM es un método eficiente para el aislamiento de estas bacterias a partir de agua

The seroprevalence of Chlamydia pneumoniae and Mycoplasma pneumoniae in hantavirus seronegative patients, who had symptoms and signs compatible with pneumonia was established. For this purpose we used the indirect fluorescent antibody test. Titers <FONT FACE=Symbol>³</FONT> 1:16 for C. pneumoniae and M. pneumoniae were found in 8.6% and 17.1% of the serum, respectively, showing evidence of recent or current infection.