Cryptococcosis is reported in adults and is often acquired immune deficiency syndrome (AIDS)-associated; however, its frequency in children is low. Based on the National Survey on Cryptococcosis conducted in Colombia, an epidemiological and clinical analysis was performed on cases of the disease observed in children less than 16 years old between 1993-2010. We found 41 affected children (2.6% prevalence) from the 1,578 surveys received. The country mean annual incidence rate was 0.017 cases/100,000 children under 16 years, while in Norte de Santander the incidence rate was 0.122 cases/100,000 (p < 0.0001). The average age of infected children was 8.4 and 58.5% were male. In 46.3% of cases, a risk factor was not identified, while 24.4% had AIDS. The most frequent clinical manifestations were headache (78.1%), fever (68.8%), nausea and vomiting (65.6%), confusion (50%) and meningeal signs (37.5%). Meningitis was the most frequent clinical presentation (87.8%). Amphotericin B was given to 93.5% of patients as an initial treatment. Positive microbiological identification was accomplished by India ink (94.7%), latex in cerebrospinal fluid (100%) and culture (89.5%). Out of 34 isolates studied, Cryptococcus neoformans var. grubii (VNI 85.3%, VNII 8.8%) was isolated in 94.1% of cases and Cryptococcus gattii (VGII) was isolated in 5.9% of cases. These data are complemented by a literature review, which overall suggests that cryptococcosis in children is an unusual event worldwide.

Introducción. Desde 1997 se viene realizando un programa nacional de vigilancia sobre la criptococosis en Colombia. Se presentan los resultados correspondientes a los pacientes diagnosticados entre el 2006 y el 2010. Objetivo. Analizar los datos obtenidos durante este periodo. Materiales y métodos. Análisis retrospectivo de las encuestas. Resultados. Durante los cinco años mencionados se recibieron 526 encuestas representativas del 72 % de la división política colombiana. La mayoría de pacientes (76,6 %) eran hombres y 74,9 % estaban entre los 21 y los 50 años. El factor de riesgo prevalente fue la infección por VIH (83,5 %), y la criptococosis definió el sida en 23 % de los casos. La incidencia anual promedio en la población general fue de 2,4 por un millón de habitantes mientras que, en pacientes con sida, aumentó a 3,3 por 1.000. En 474 encuestas se informaron manifestaciones clínicas; las más frecuentes fueron: cefalea (84,5 %), fiebre (63,4 %), náuseas y vómito (57,5 %), alteraciones mentales (46,3 %), signos meníngeos (33 %), tos (26,4 %) y alteraciones visuales (24,5 %). La neurocriptococosis se reportó en 81,8 % de los casos. El diagnóstico se hizo por examen directo, cultivo y antigenemia en 29,3 % de los casos. De 413 aislamientos recuperados, 95,6 % fueron C. neoformans var. grubii, 1 % C. neoformans var. neoformans, y 3,4 % C. gattii. En 71,6 % de los casos para el tratamiento se administró anfotericina B y en 28 % se combinó con fluconazol. Conclusiones. La vigilancia pasiva continúa siendo un marcador centinela para la infección por VIH, y constituye una aproximación sistemática al estudio de infecciones oportunistas en pacientes con sida, debido a que la criptococosis no es de notificación obligatoria en Colombia

Introduction: A survey on cryptococcosis is being conducted regularly in Colombia since 1997. We present hereby the results corresponding to patients diagnosed from 2006 to 2010. Objective: To analyze the data obtained during this period. Materials and methods: Retrospective analysis of the corresponding surveys. Results: A total of 526 surveys originating from 72% of the Colombian political divisions were received during the 5-year period. Most patients (76.6%) were males and 74.9% were 21-50 years old. The most prevalent risk factor was HIV infection (83.5%) with cryptococcosis defining AIDS in 23% of the cases. In the general population the estimated mean annual incidence rate for cryptococcosis was 2.4 x 106 inhabitants while in AIDS patients this rate rose to 3.3 x 103. In 474 surveys stating clinical features, most frequent complaints were headache 84.5%, fever 63.4%, nausea and vomiting 57.5%, mental alterations 46.3%, meningeal signs 33.0%, cough 26.4% and visual alterations 24.5%. Neurocryptococcosis was recorded in 81.8% of the cases. Laboratory diagnosis was based on direct examination, culture and latex in 29.3% cases. From 413 Cryptococcus isolates analyzed, 95.6% were identified as C. neoformans var. grubii, 1% C. neoformans var. neoformans, and 3.4% C. gattii. Treatment was reported for 71.6% of the cases with amphotericin B alone or in combination with fluconazole prescribed in 28%. Conclusions: Surveys done through passive surveillance continue to be sentinel markers for HIV infection and represent a systematic approach to the study of opportunistic problems regularly afflicting AIDS patients since cryptococcosis requires no compulsory notification in Colombia.

Objectives This work describes Post-abortion Care strategy (PAC) experience in 13 Colombian hospitals regarding three components (counselling, suitable treatment and family planning). Methods The study had quantitative (cross-sectional study) and qualitative components. Population: Colombian hospitals receiving PAC training between 1999 and 2002 and fulfilling inclusion and exclusion criteria. Sequential convenience sampling was used; 127 patients, 13 managers and 39 health-care providers were interviewed. Results 26,199 women were treated for incomplete abortion during the study period. 40 % were treated using Manual Vacuum Aspiration (MVA) and 60 % using sharp curettage (SC). Family planning counselling was provided for 99,8 % of MVA cases; however, only 57,3 % of SC cases received it. There were 9 uterine perforations using SC and none in MVA cases (Chi square: 2.16; p=0.14). There were 2 vagal reactions using MVA. Uterine evacuation was needed in 13 SC cases but in only one MVA case (Chi square: 6,25 p=0.01). Patient satisfaction levels with hospital treatment were evaluated: 90 % of those receiving MVA treatment reported being satisfied or very satisfied, compared to just 60 % of those treated with SC. All health-care providers and 12 out of 13 managers reported satisfaction with the PAC strategy and with 12 out of 13 managers as well. Conclusions MVA treatment was associated with less treatment-related morbidity and higher levels of satisfaction amongst patients. Most managers and all health-care providers stated their satisfaction with the PAC strategy.

Objetivos El propósito de este trabajo es describir la experiencia con la estrategia de Atención Integral al Posaborto (APA) en 13 hospitales Colombianos en lo referente a tres componentes: Consejería, tratamiento y planificación familiar. Métodos Estudio mixto con un componente cuantitativo (corte transversal) y otro cualitativo. Población: Hospitales en Colombia que recibieron capacitación en APA entre 1999 y 2002 y que cumplieron con criterios de inclusión y exclusión. Se hizo un muestreo secuencial por conveniencia, entrevistando 127 pacientes, 13 gerentes, y 39 proveedores. Resultados Entre 1999 y 2002 se atendieron 26 199 mujeres con aborto incompleto. Se trataron con legrado uterino por aspiración manual (LUA) el 40 % y con legrado uterino con cureta (LUC) el 60 %. En los casos de LUA se brindó consejería en el 99,8 % y en los de LUC en 57,3 %. Utilizando LUA no hubo perforaciones uterinas aunque hubo 2 reacciones vagales mientras con LUC hubo 9 perforaciones uterinas (Chi²: 2,16; p=0,14). Con LUC hubo necesidad de reaspiración por evacuación incompleta en 13 casos mientras que en LUA en un caso (Chi²: 6,25 p=0,01). Las pacientes sometidas a LUA refirieron haber estado muy satisfechas y satisfechas en más del 90 % mientras que para LUC el grado de satisfacción fue del 60 %. Manifestaron satisfacción con la estrategia APA todos los proveedores y 12 de 13 gerentes. Conclusiones La técnica LUA presentó menor morbilidad y mayor satisfacción en las usuarias. La mayoría de los gerentes y la totalidad de los proveedores manifestaron satisfacción con la estrategia APA.

Objetivos El propósito de este trabajo es describir la experiencia con la estrategia de Atención Integral al Posaborto (APA) en 13 hospitales Colombianos en lo referente a tres componentes: Consejería, tratamiento y planificación familiar. Métodos Estudio mixto con un componente cuantitativo (corte transversal) y otro cualitativo. Población: Hospitales en Colombia que recibieron capacitación en APA entre 1999 y 2002 y que cumplieron con criterios de inclusión y exclusión. Se hizo un muestreo secuencial por conveniencia, entrevistando 127 pacientes, 13 gerentes, y 39 proveedores. Resultados Entre 1999 y 2002 se atendieron 26 199 mujeres con aborto incompleto. Se trataron con legrado uterino por aspiración manual (LUA) el 40 % y con legrado uterino con cureta (LUC) el 60 %. En los casos de LUA se brindó consejería en el 99,8 % y en los de LUC en 57,3 %. Utilizando LUA no hubo perforaciones uterinas aunque hubo 2 reacciones vagales mientras con LUC hubo 9 perforaciones uterinas (Chi²: 2,16; p=0,14). Con LUC hubo necesidad de reaspiración por evacuación incompleta en 13 casos mientras que en LUA en un caso (Chi²: 6,25 p=0,01). Las pacientes sometidas a LUA refirieron haber estado muy satisfechas y satisfechas en más del 90 % mientras que para LUC el grado de satisfacción fue del 60 %. Manifestaron satisfacción con la estrategia APA todos los proveedores y 12 de 13 gerentes. Conclusiones La técnica LUA presentó menor morbilidad y mayor satisfacción en las usuarias. La mayoría de los gerentes y la totalidad de los proveedores manifestaron satisfacción con la estrategia APA.

Objectives This work describes Post-abortion Care strategy (PAC) experience in 13 Colombian hospitals regarding three components (counselling, suitable treatment and family planning). Methods The study had quantitative (cross-sectional study) and qualitative components. Population: Colombian hospitals receiving PAC training between 1999 and 2002 and fulfilling inclusion and exclusion criteria. Sequential convenience sampling was used; 127 patients, 13 managers and 39 health-care providers were interviewed. Results 26,199 women were treated for incomplete abortion during the study period. 40 % were treated using Manual Vacuum Aspiration (MVA) and 60 % using sharp curettage (SC). Family planning counselling was provided for 99,8 % of MVA cases; however, only 57,3 % of SC cases received it. There were 9 uterine perforations using SC and none in MVA cases (Chi square: 2.16; p=0.14). There were 2 vagal reactions using MVA. Uterine evacuation was needed in 13 SC cases but in only one MVA case (Chi square: 6,25 p=0.01). Patient satisfaction levels with hospital treatment were evaluated: 90 % of those receiving MVA treatment reported being satisfied or very satisfied, compared to just 60 % of those treated with SC. All health-care providers and 12 out of 13 managers reported satisfaction with the PAC strategy and with 12 out of 13 managers as well. Conclusions MVA treatment was associated with less treatment-related morbidity and higher levels of satisfaction amongst patients. Most managers and all health-care providers stated their satisfaction with the PAC strategy.