Revista Medica Herediana

The AIDS Epidemic: Situation in Peru until 2005

Morbidity and mortality at the inpatient unit of the Tropical Medicine, infectious diseases and dermatology Department at the Hospital Nacional Cayetano Heredia between 1990 - 2000.

Objetivo: Describir la demografía, e identificar la morbilidad más frecuente y las tasas de mortalidad de la unidad de enfermedades infecciosas en un hospital de referencia, público y docente, localizado en el norte de Lima-Perú. Material y métodos: Se realizó un estudio retrospectivo donde se incluyeron todas las hospitalizaciones del Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas del Hospital Nacional Cayetano Heredia, entre enero de 1990 y diciembre del 2000. Se registraron los datos demográficos, las fechas de ingreso y de alta, todos los diagnósticos, y la condición al alta. Los diagnósticos fueron codificados según la Novena Revisión de la Clasificación Internacional de Enfermedades (CIE-9). Resultados: De 7192 hospitalizaciones registradas, 4603 (64%) fueron de pacientes varones, la edad media fue 39.2 ±19 años. Las hospitalizaciones prácticamente se duplicaron (de 440 a 817) durante el periodo en estudio. La edad media aumentó de 36.6 ±16.1 años a 41 ± 19.9 años, las hospitalizaciones de pacientes geriátricos aumentó de 11.8% a 21.3%, y la relación VIH/ no VIH aumentó de 0.07 a 0.25. El índice de rotación de cama aumentó de 12.2 a 22.7. Los diagnósticos más frecuentes fueron: VIH 1209 (10.2%), tuberculosis 1201 (10.1%), celulitis 653 (5.5%) y neumonía 651 (5.5%). La mortalidad hospitalaria durante el estudio fue de 8.1%, manteniéndose en promedio constante. Conclusiones: Se observó un aumento en el número de hospitalizaciones, especialmente debido a pacientes geriátricos, sin encontrarse cambios en las tasas de mortalidad. Tuberculosis y VIH fueron los diagnósticos más frecuentes en este estudio. (Rev Med Hered 2004; 15:181-187).

Objective: To describe demographic characteristics, morbidity and in-hospital mortality at the infectious diseases unit in a public reference teaching hospital in northern Lima-Peru. Material and Methods: A retrospective study was conducted including all admissions from January 1st, 1990 to December 31, 2000, recorded in the discharge book of the Department of Infectious, Tropical and Dermatological Diseases of the Hospital Nacional Cayetano Heredia. Demographic characteristics, dates of admission and discharge, diagnoses, and discharge status were registered. Diagnoses were classified using the International Classification of Diseases, version 9 (ICD-9). Results: We recorded 7192 admissions, 4603 (64%) were male, the mean age was 39.2 ± 19.0 years. The number of admissions per year almost duplicated (from 440 to 817) during the study period. The mean age increased from 36.6± 16.1 to 41±19.9 years; admissions of elderly patients increased from 11.8% to 21.3%, and the HIV/non-VIH ratio increased from 0.07 to 0.25. The admission/bed ratio augmented from 12.2 to 22.7. The most frequent diagnoses were: HIV 1209 (10.2%), tuberculosis 1201 (10.1%), skin and soft tissue infections 653 (5.5%) and pneumonia 651 (5.5%). The overall in-hospital mortality was 8.1%, remaining constant throughout the study. Conclusions: There have been an increasing number of admissions in this setting, particularly of elder patients, without changes in overall mortality. Tuberculosis and HIV were the two most frequent diagnoses. (Rev Med Hered 2004;15:181-187).

Acute surgical abdomen in patients infected with the Human Immunodeficiency Virus at the Hospital Nacional Cayetano Heredia

Objetivo: Determinar las características epidemiológicas y clínico quirúrgicas del abdomen agudo quirúrgico (AAQ) en pacientes con diagnóstico de infección por el Virus de Inmunodeficiencia Humana (VIH). Material y métodos: Estudio descriptivo retrospectivo de serie de casos en el Hospital Nacional Cayetano Heredia (HNCH) durante el periodo 1997 - 2002. Resultados: Se incluyeron 23 pacientes: 19 varones y 4 mujeres; las manifestaciones clínicas fueron: dolor abdominal, signos de irritación peritoneal, fiebre, nauseas, ruidos hidroaéreos disminuidos y distensión abdominal. Los procedimientos quirúrgicos realizados fueron: resección intestinal (26.1%), apendicectomía (26.1%), biopsia de ganglios (21.74%), colecistectomía (17.4%), lisis de bridas y adherencias (4.35%), drenaje de absceso (4.35%) y resección tumoral (4.35%). Se realizó estudio anatomopatológico en 82.61%. La morbilidad fue 56.5%, debidas a: neumonía (26.1%), infección de herida operatoria (21.74%), fístula enterocutánea de gasto alto (21.74%), fiebre (21.74%), dehiscencia de herida operatoria (13%), trastorno hidroelectrolítico (13%), diarrea persistente (8.7%), deshidratación moderada (8.7%), íleo paralítico (4.35%) y, síndrome adherencial (4.35%). El 50% de resecciones intestinales por perforación intestinal presentaron fístulas enterocutáneas. La mortalidad post operatoria fue 21.74%. Conclusiones: El 1.82% de pacientes infectados por el VIH, atendidos en el HNCH presentaron AAQ. Los procedimientos quirúrgicos más frecuentes fueron: apendicectomía convencional y resección intestinal con anastomosis. El examen anatomopatológico mostró: bacilo de Koch, seguido de Citomegalovirus y linfoma no Hodgkin. En el 26.1% de los casos se realizaron intervenciones quirúrgicas (laparotomías) innecesarias. Las complicaciones post operatorias más frecuentes fueron: neumonía (26.1%), infección de herida operatoria (21.74%), fístula enterocutánea de gasto alto (21.74%) y, fiebre (21.74%). La causa más frecuente de mortalidad fue shock séptico. (Rev Med Hered 2004;15:188-196).

Objective: To determine epidemiological, clinical and surgical characteristics of acute abdomen in patients with Human Immunodeficiency Virus infection (HIV). Material and methods: This is a retrospective and descriptive study of serial cases, was performed between 1997 and 2002 at the Hospital Nacional Cayetano Heredia. Results: We include 23 patients: 19 males and 4 females; the clinical findings was: abdominal pain, peritoneal irritation signs, fever, nausea, abdominal distention. Surgical procedures were: intestinal resection (26.1%), appendectomy (26.1%), ganglionar biopsy (21.74%), colecistectomy (17.4%), bridle and adhesion rupture (4.35%), abscess drainage (4.35%) and tumoral resection (4.35%). The pathological anatomy study was performed in 82.61%. The morbility was 56.5%, and the causes: pneumonia (26.1%), surgical injury infection (21.74%), abdominal fistula (21.74%), fever (21.74%), dehiscence surgical injury (13%), persistent diarrhea (8.7%), moderate dehydration (8.7%), paralytic ileus (4.35%) and adhesional syndrome (4.35%). 50% of intestinal resections due to intestinal perforation have abdominal fistula. The mortality was 21.74%. Conclusions: 1.82% of patients with diagnosis of Human Immunodeficiency Virus infection (HIV) had acute abdominal surgical. Surgical procedures more frequent were appendectomy and intestinal resection. The pathological anatomy study showed bacilli of Koch, Citomegalovirus and lymphoma no Hodgkin. At 26.1% of cases was performed unnecessary surgical procedures (laparotomy). Complications more frequent were: pneumonia (26.1%), injury infection (21.74%), abdominal fistula (21.74%) and fever (21.74%). The most frequent cause of mortality was septic shock. (Rev Med Hered 2004;15:188-196).

Association between infection with human T Cell lymphotrophic virus type I (HTLV-I) and mortality in hospitalized patients with tuberculosis

El Perú es un país de alta prevalencia de tuberculosis (TBC) y endémico para la infección por el virus linfotrópico humano de células T tipo I (HTLV-I). Objetivo: Determinar la asociación entre la infección por HTLV-I y la mortalidad de los pacientes hospitalizados por TBC. Material y métodos: Los pacientes que ingresaron consecutivamente con el diagnóstico de TBC a los servicios de hospitalización de los Departamentos de Medicina Interna y de Enfermedades Infecciosas, Tropicales y Dermatológicas del Hospital Nacional Cayetano Heredia fueron entrevistados y sometidos a una prueba diagnóstica para la infección por HTLV-I. Se revisaron sus historias clínicas y los libros de altas para definir el resultado de la hospitalización. Las variables clínicas y epidemiológicas que estuvieron asociadas con mortalidad durante la hospitalización en el análisis univariado fueron incluidos en un modelo de regresión logística múltiple. Resultados: Se incluyeron 193 pacientes hospitalizados con TBC; 14 tuvieron infección por HTLV-I (7.3%). En el análisis multivariado, la infección por HTLV-I (OR ajustado 9.4; IC 2.2 - 40.6), TBC meníngea (OR ajustado 3.8; IC 1.3 - 11.5) y la condición de infección por VIH desconocido (OR ajustado 0.2; IC 0.04 - 0.6) se encontraron asociadas con la mortalidad durante la hospitalización. Conclusión: Este estudio demuestra que la infección por HTLV-I es frecuente entre los pacientes hospitalizados con TBC y que existe una relación independiente entre esta infección y la mortalidad durante la hospitalización.(Rev Med Hered 2004;15:197-202).

Peru is endemic for both human T-cell lymphotropic virus type I (HTLV-I) and tuberculosis (TBC). Objective: Assess the association between HTLV-I infection and mortality among inpatients with TBC. Material and Methods: Consecutive patients admitted to the Departments of Internal Medicine and Infectious, Tropical and Dermatological diseases of the Hospital Nacional Cayetano Heredia with a diagnosis of TBC were interviewed and they were tested for HTLV-I. The hospital registries were reviewed to determine the outcome of hospitalization. Clinical and epidemiological variables that were associated with death during hospitalization on univariate analysis were included in a model of multiple logistic regression. Results: We included 193 inpatients with TBC; 14 were HTLV-I positive (7.3%). In the multivariable analysis, HTLV-I infection (adjusted OR 9.4; CI 2.2 - 40.6), TBC meningitis (adjusted OR 3.8; CI 1.3 - 11.5) and unknown HIV infection status (adjusted OR 0.2; CI 0.04 - 0.6) were associated with death during hospitalization. Conclusions: HTLV-I is a frequent infection among inpatients with TBC and there is an independent association between HTLV-I infection and mortality among inpatients with TBC. (Rev Med Hered 2004;15:197-202).

Morbidity and mortality of patients with tuberculosis hospitalized at the Tropical Medicine, Infectious Diseases and Dermatology Department at the Hospital Nacional Cayetano Heredia from Lima-Peru, between 1990 - 2000

Objetivos: Describir las características clínico-epidemiológicas y la mortalidad de pacientes hospitalizados con tuberculosis (TBC) en el Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas del Hospital Nacional Cayetano Heredia (DEITD-HNCH) de Lima, Perú. Material y Métodos: Estudio retrospectivo y observacional que incluyó a pacientes hospitalizados desde enero de 1990 hasta diciembre de 2000 con diagnóstico de TBC definitiva o probable. Resultados: Se registraron 1340 altas con diagnóstico de TBC (18.7 %). La edad promedio de los pacientes hospitalizados con TBC fue 33.5 ± 15.1 años, 69.2% fueron varones y 28.1 % tuvieron infección por el Virus de la Inmunodeficiencia Humana (VIH). La mortalidad por TBC fue 17.2 % y permaneció constante durante el período. El número de muertes por TBC (230 pacientes) representó el 37.5 % de las muertes por todas las causas (613 pacientes). De los fallecidos por TBC, 151 (65.6 %) tuvieron TBC multisistémica, 60 (26.1 %) TBC pulmonar y 19 (8.3 %) TBC extrapulmonar exclusiva. Hubo sospecha clínica de TBC multidrogorresistente (TBC-MDR) en 51 (22.2 %) pacientes fallecidos. Edad mayor de 30 años (OR=1.6, 1.2Objectives: To describe clinical and epidemiological characteristics and mortality of inpatients with tuberculosis (TB) at a department of infectious diseases of a public hospital in Peru. Material and methods: We conducted a retrospective and observational study and included patients with a definite or probable diagnosis of TB hospitalized at the Department of Infectious Diseases of the Hospital Nacional Cayetano Heredia (DEITD-HNCH) in Lima between January 1990 and December 2000. Results: There were registered 1340 admissions of patients with TB (18.7 %). The mean age of inpatients with TB was 33.5 ± 15.1 years; 69.2 % were men and 28.1% of TB patients were known to be infected with HIV. Mortality among TB patients was 17.2 % and kept constant during the period. Death because of TB (230 patients) represented 37.5 % of all death causes (613 patients). Among patients who died during the admission for TB, 151 (65.6 %) had multisystemic TB, 60 (26.1 %) had pulmonary TB and 19 (8.3 %) had extrapulmonary TB exclusively. There was clinical suspicion of multidrug-resistant TB (MDR-TB) in 51 (22.2 %) of the deceased patients. On multivariate analysis, being older than 30 years (OR=1.6, IC 95% 1.2-2.1) and having HIV infection (OR=5.4, IC 95% 4.0-7.3) were associated with mortality. Conclusions: TB represented 18.7% from the whole diagnostics and 37.5% from the whole deaths. The mortality related to TB in a unit of infectious diseases of a public reference hospital has not decreased over the last 11 years. Age over 30 years and being HIV infected were independently associated with death during hospitalization for TB. (Rev Med Hered 2004; 15:203-210).

Lymph node Mycosis: report of 7 cases at the Hospital NacionalCayetano Heredia Lima-Perú and Review of the Literature

Objetivos: Describir las características clínicas, micológicas e histopatológicas de una serie de pacientes con micosis ganglionar y determinar si las afecciones ganglionares por hongos o micosis ganglionares pueden imitar otras patologías ganglionares infecciosas y no infecciosas. Material y Métodos: Se evaluaron 154 pacientes atendidos en el Departamento de enfermedades infecciosas y transmisibles del Hospital Nacional Cayetano Heredia de Lima entre enero del 2003 y enero del 2004. Estos pacientes participaron en un estudio de validación de una prueba diagnóstica para tuberculosis ganglionar pero tuvieron un diagnóstico definido de micosis ganglionar. Resultados: De 154 pacientes con linfadenopatía evaluados durante el tiempo de estudio, 7 tuvieron micosis ganglionar, dos de ellos eran pacientes inmunocompetentes y los cinco restantes inmunosuprimidos, uno por linfoma y los otros por VIH. Conclusiones: Las afecciones ganglionares por hongos o micosis ganglionares pueden ser grandes imitadoras de otras patologías ganglionares infecciosas y no infecciosas. (Rev Med Hered 2004;15:211-217).

Objective: Describe clinical, mycological and histopathological characteristics of a series of patients with lymph node mycosis. Material and Methods: All patients here described were attended at the Hospital Nacional Cayetano Heredia in Lima between January 2003 and January 2004. These patients participated in a study on the accuracy of a diagnostic test for tuberculosis but got a definite diagnosis of lymph node mycosis. Results: Of 154 patients with lymphadenopathy evaluated during the study period, 7 were diagnosed with lymph node mycosis. Two were immunocompetent patients and 5 had immune suppression, one because of lymphoma and 4 because of HIV infection. Conclusions: There can be a strong resemblance between lymph node mycosis and lymphadenopathy caused by other infectious and non infectious diseases. (Rev Med Hered 2004;15:211-217).

Influence of climatic factors on infectious diseases

Several epidemiological evidence have been correlated with the effect of environmental factors over infectious diseases. Since the El Niño phenomenon in 1973, this event has been incriminated in the onset or trigger of epidemic changes and outbreaks. El Niño, which is responsible for the Ecuatorial Pacific Ocean water warming, produce a global effect, and as a consequence atmospheric humidity and environmental temperature are higher than usual. Currently, there are evidence that those changes have a direct effect on the biological life cycle of infectious diseases vectors and some microorganisms with a correlation in the epidemiology of those diseases. Recently, the molecular biology and the mathematical model analysis have been improving our understood about biological explanations, allowing the opportunity to predict outbreaks, risky areas, or epidemiological changes. We review the current evidence that may affect infectious diseases, as Malaria, Leishmaniasis, Bartonellosis, Cholera and others. (Rev Med Hered 2004;15:218-224).

Human Rights and Health: the Case of HIV/AIDS

The history of HIV/AIDS (Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome) has shown us, continuously, many experiences in the political, moral, economic, social, therapeutic and clinical areas, amongst others. Due to the various and diverse implications of this complex problem, a solitary analysis framed by only one of those fields results difficult and inappropriate. We argue that a human rights approach should be undertaken to understand and address this problem. The advantage of this type of analysis goes beyond clinical aspect of the patient, and thus provides an integral vision that every health professional should handle in a day-to-day basis.(Rev Med Hered 2004;15:225-228).

Tenosinovitis caused by Mycobacterium chelonae: Report of a case

We report a patient with a diagnosis of synovial tenosynovitis who developed septic tenosinovitis with cold abscess on right hand, after a local punction. Mycobacterium chelonae a fast-growing mycobacteria, was isolated. We discuss aspects related to differential diagnosis, epidemiology, risk factors. diagnostic procedures and issues related to treatment of this nosocomial infection. (Rev Med Hered 2004;15:229-231).