PubMed Health⌕ Search

Biomedical subjects

S Ponce de León

Publications and source records attributed to S Ponce de León.

At least 19 recordsLinked to original sources
PubMed1999

An epidemic outbreak of Malassezia folliculitis in three adult patients in an intensive care unit: a previously unrecognized nosocomial infection.

BACKGROUND: Malassezia is a lipophilic fungus commonly found in normal human skin. Infection of the hair follicle by Malassezia furfur occurs in patients with predisposing factors such as diabetes or immunosuppression, or who are undergoing antibiotic treatment. Malassezia furfur folliculitis is an infrequent nosocomial infection which may be associated with fomite transmission. METHODS: We reviewed the clinical files of three adult patients from an intensive care unit (ICU) who simultaneously developed folliculitis through Malassezia infection. We specifically analysed predisposing factors, possible transmission modes, characteristics of skin lesions, results of biopsies and cultures, treatment, and patient outcome. RESULTS: The three male patients were in neighboring beds and they all had factors that predisposed them to underlying immunosupression. Simultaneously, and within hours of each other, they developed erythematous follicular papules and pustules on the face and chest. The skin biopsies revealed an acute folliculitis with abundant round to oval yeasts of up to 5 microm in diameter. Stains for fungi (Schiff's peryodic acid, Grocott and silver methenamine) revealed numerous unipolar budding yeasts without hyphae, consistent with M. furfur. Conventional cultures were negative. The diagnosis of folliculitis by M. furfur was established and antifinigal treatment initiated, with adequate outcome of the dermatosis. After this outbreak, the aseptic and hygienic measures of the health care personnel of the ICU were reviewed and corrected. CONCLUSIONS: The simultaneous emergence of this superficial infection by M. furfur suggests fomite participation. This dermatomycosis is an infrequent nosocomial infection in adults, which to our knowledge has not been previously reported.

Adult↗
PubMed1999

Colonization of Mexican patients by multiple Helicobacter pylori strains with different vacA and cagA genotypes.

Helicobacter pylori virulence determinants have not previously been studied in detail in Latin Americans with H. pylori infections. We characterized the vacA (vacuolating cytotoxin gene A) and cagA (cytotoxin-associated gene A) types of more than 400 single-colony isolates from 20 patients in Mexico City. For 17 patients H. pylori strains of two or more different vacA genotypes were isolated from gastric biopsy specimens, indicating infection with two or more strains of H. pylori. The most frequent vacA genotype was s1b/m1. vacA diversity was more marked than that described previously, in that isolates from seven patients had untypeable vacA midregions and isolates from nine patients had type s1 signal sequence coding regions which could not be further subtyped. Previously undescribed vacA type s2/m1 strains were found in five patients. All patients were infected with cagA-positive strains, but occasionally, these coexisted with small numbers of cagA-negative strains. In conclusion, coinfection with multiple H. pylori strains is common in Mexico, and vacA in these strains is genetically more diverse than has been described in other populations.

Adult↗
PubMed1999

[Nosocomial infections: secular trends of a control program in Mexico].

OBJECTIVE: To know the trend of nosocomial infections rates at a third level hospital since the beginning of the infection control program until the present and to evaluate the impact in mortality and length of hospital stay. MATERIAL AND METHODS: A study descriptive, retrospective and retrolective was done in a reference hospital providing tertiary care in Mexico City. Recorded data included rates, type of nosocomial infections and distribution of nosocomial infections from the database of Hospital Epidemiology Division between 1991 to 1996. In every patient the degree of severity disease was evaluated according to the McCabe-Jackson's scale, we also collected age and the length of stay. Statistical analysis was done with chi 2 test for tendencies of different evaluated parameters. This study was divided in three periods: before remodel (1991-1993), to remodel (1994-1995) and after remodel (1996). Compared the before remodel period against after remodel period. RESULTS: In the study period, mean nosocomial infections ratio was of 8.6 by 100 discharges, showing a decrease of 20% (p < 0.01). Hospital area with the highest infections rate was ICU (26.9 by 100 discharge), followed by general ward of hospitalization with shared rooms (9.47) and private rooms (7.5). Urinary tract infections was the most frequent (26.6%), followed by surgical wound infection (24.4%), pneumonia (12.1%) and primary bacteremia (9.5%). Rates of urinary tract infections and primary bacteremias had decreased significantly (p < 0.05 and p < 0.00001 respectively), while surgical wound infections and pneumonias increased (p < 0.005 and p < 0.00001 respectively). Associated mortality diminished in 36% (p < 0.00001). The length of stay diminished 42.8%. There was not differences in the severity of disease along this period. CONCLUSIONS: Since the establishment of the nosocomial infections surveillance and control program at the INNSZ on 1985, nosocomial infections rate (56%) and the associated mortality (36%) have diminished. These changes are consequence of the establishment of a nosocomial infections control program and the decrease of length of stay and does not seems to be related to the age or to the severity of the disease of the hospitalized patients.

Age Factors↗
PubMed1996

Prognostic value of oral candidosis and hairy leukoplakia in 111 Mexican HIV-infected patients.

A follow-up study was carried out to evaluate the prognostic value of hairy leukoplakia (HL) and oral candidosis (OC) in a cohort of 111 asymptomatic Mexican HIV infected patients. Oral exams were performed at baseline and every 6 months, from September 1989 to March 1994. Chi-square contingency table test, the Kruskall-Wallis one-way analysis of variance, the Kaplan-Meier product-limit method and the log rank test were used for the analysis. Univariate and multivariate Cox's proportional hazards analysis were also performed. Fifty-four patients (51%) progressed to AIDS (initially 36 CDC-II and 18 CDC-III). Individuals with HL and/or OC, showed faster development to AIDS than subjects without lesions or other HIV-related manifestations (P = 0.008). The presence of OC, HL or both always remained significant despite adjustment for total lymphocytes, CDC stage, zidovudine therapy or its combinations. Oral lesions in HIV infection may be regarded with other clinical and laboratory studies as markers of HIV disease progression and as indicators to begin antiretroviral treatment.

AIDS-Related Opportunistic Infections↗
PubMed1992

The spectrum of clinical and pathological manifestations of AIDS in a consecutive series of autopsied patients in Mexico.

OBJECTIVE: Little is known about the clinical profile of AIDS in Latin American populations. This study characterizes the clinical and pathological manifestations of AIDS in a representative series of Mexican AIDS patients at autopsy. DESIGN: The clinical and pathological findings were abstracted retrospectively for a sequential series of autopsied AIDS patients. SETTING: Autopsies were conducted at the four major tertiary level hospitals that serve the majority of AIDS patients in Mexico City. PATIENTS: Subjects included 177 consecutive patients diagnosed with AIDS between March 1984 and January 1989 who subsequently died and were autopsied in the same period in the study hospitals. MAIN OUTCOME MEASURES: Demographic characteristics, including age, gender, residence, socioeconomic status, and risk group; clinical presentation and autopsy findings, including opportunistic infections and malignancies. RESULTS: Sixty per cent of the AIDS patients presented with wasting syndrome. The most common infections were cytomegalovirus (69%), tuberculosis (25%), and Pneumocystis carinii pneumonia (24%). Central nervous system infections were also common and included toxoplasmosis (19%) and cryptococcoses (10%). Kaposi's sarcoma was present in 30% of cases and non-Hodgkin's lymphoma in 9%. CONCLUSION: Clinical manifestation, and types and frequency of opportunistic infections in our Mexican AIDS patients were more similar to those seen in AIDS patients in Africa and Haiti than in the United States and Europe. These findings suggest that the AIDS epidemic in Mexico has an 'intermediate' pattern and may be a prototype for Latin American countries.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Major recurrent oral ulcers in AIDS: report of three cases.

We report the cases of three AIDS patients who developed major recurrent oral ulcers with severe odynophagia and weight loss. The patients were treated successfully with systemic steroids. Within the first week of prednisone therapy (40 mg/day), the symptoms improved and the lesions entirely healed. We suggest, on the bases of recent literature, that superantigens and the cytokine network could be involved and they should be considered in the immunopathogenic mechanisms of this type of ulcers.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Hospital-acquired diarrhea in adults: a prospective case-controlled study in Mexico.

OBJECTIVE: To know the incidence, etiology, risk factors, morbidity, and mortality of nosocomial diarrhea in adults. DESIGN: Nested case-control study, matched by service, length of stay, date of admission, and presence of leukopenia and/or the acquired immunodeficiency syndrome (AIDS). Cases were those who developed nosocomial diarrhea. Controls were those who did not develop nosocomial diarrhea during a comparative period nor during the next ten days. Stool samples were processed in search for parasites, yeasts, bacteria, and rotavirus. SETTING: Third-level referral center, in Mexico City, Mexico, for general internal medicine and surgical problems. PATIENTS: Eligible subjects were all new admissions to the hospital from November 1987 to September 1988. Reasons for exclusion were presence of chronic diarrheal disease or melena. There were 115 cases and 111 controls. RESULTS: Overall risk of acquiring nosocomial diarrhea was 5.5%, or 1.8 episodes per 100 patient-weeks. A potential pathogen was found in 59%. Yeasts and Entamoeba histolytica were the most frequently isolated pathogens. Mortality in cases was 18%, as compared with 5% in controls (p less than .01). Multivariate analysis showed enteral feeding, recent enemas, presence of Candida species, use of antacids/H2-blockers, and presence of nasogastric tubes as significant risk factors for nosocomial diarrhea. CONCLUSIONS: Diarrhea is a common complication in hospitalized patients. It occurs more often than previously suspected and is linked with a substantial mortality. The spectrum of etiologic agents is different from that reported in pediatric hospitals. Given that nosocomial diarrhea may constitute, at least, a marker of severity of illness, it should receive more attention in general hospitals.

Adult↗
PubMed1990

Oral lesions in Mexican HIV-infected patients.

One hundred and twenty-five HIV-infected patients, of whom 49 (39%) were at early stages of the infection (CDC-II & III) and 76 (61%) in CDC IV, were prospectively examined. In 100 (80%) one or more oral mucosal lesions were observed; candidiasis (51%) and hairy leukoplakia (43%) were the commonest. Erythematous candidiasis was more often seen (35%) than the pseudomembranous type (16%), and appeared with the higher values at early than later stages. The prevalence of hairy leukoplakia, oral hyperpigmentation and xerostomia were incremented in groups CDC-IV. Pseudomembranous candidiasis and exfoliative cheilitis increased significantly with severity of disease. Our study demonstrates that oral alterations associated to HIV are a frequent finding, both at early (76%) and late (83%) stages of the infection in Mexican patients.

Adolescent↗
PubMed1989

Epidemic of Serratia marcescens bacteremia and meningitis in a neonatal unit in Mexico City.

A case-control study was conducted on an epidemic of bacteremia and meningitis caused by Serratia marcescens in the neonatal intensive care unit and special care nursery of a general hospital in Mexico City, Mexico. A 19.9% incidence of bacteremia and meningitis was recorded in contrast to 1.4% and 3.7% during preepidemic and post-epidemic periods; a 69% mortality rate was observed. Peripheral IV catheters and the use of mixed IV fluids prepared in the wards were the major risk factors (P less than 0.001). Rectal and nasopharyngeal cultures were positive in 68% of asymptomatic neonates and hand cultures were positive in 16.7% of personnel. Strains were resistant to all aminoglycosides and broad-spectrum penicillins, and belonged to the A5/8 biogroup. Containment of this outbreak was difficult because of failure to identify colonized infants early in the epidemic and because of persistent carriage of S marcescens by personnel. Comparisons between this hospital and tertiary care centers in Mexico suggest that in developing countries nosocomial infections could be of greater magnitude in secondary than in tertiary level centers.

Cross Infection↗
PubMed1989

Antiphospholipid antibodies and the antiphospholipid syndrome in systemic lupus erythematosus. A prospective analysis of 500 consecutive patients.

Five hundred consecutive patients with systemic lupus erythematosus (SLE) were entered into a prospective study of anticardiolipin antibodies (ACLA) in their 3 major immunoglobulin isotypes and followed thereafter with repeated testing for a mean period of nearly 8 months. Manifestations of SLE that were strongly associated with ACLA included venous thrombosis (particularly when recurrent), thrombocytopenia, hemolytic anemia, recurrent fetal loss, and leg ulcers. Other manifestations found to be associated with ACLA were arterial occlusions, transverse myelitis, and pulmonary hypertension. Conversely, we found no relationship between ACLA and migraine, convulsions, transient ischemic attacks, psychoses, or avascular necrosis of bone. No relationship was found between the presence of ACLA and that of anti-DNA antibodies studied in the same serum sample. Association with ACLA grew stronger and titers became higher in patients with several of the associated manifestations. Statistical analyses revealed the existence of a syndrome, the antiphospholipid syndrome, comprising 2 or more manifestations in conjunction with ACLA titers 5 standard deviations above the mean of normal control subjects, particularly if ACLA had been positive on at least 2 occasions. We propose that such criteria could be applied to the definition of the antiphospholipid syndrome. The presence and the titers of these antibodies related to disease activity and titer decreased by treatment, particularly when they were of the IgM isotype. Patients in whom a thrombotic episode occurred during the course of the study were observed to have a coincident decrease in ACLA titers, a finding that might indicate consumption of the antibody during the event. Treatment and the resulting inactivation of disease appear to have independent effects on ACLA titers. Physicians should therefore be cautious in prescribing high doses of corticosteroids or immunosuppressants to patients with SLE solely because they have high titers of ACLA.

Abortion, Spontaneous↗
PubMed1989

Hemocytopenia in systemic lupus erythematosus. Relationship to antiphospholipid antibodies.

We studied 500 consecutive patients with systemic lupus erythematosus (SLE) for antibodies to phospholipids (APLA) by an ELISA method using cardiolipin as antigen and antiimmunoglobulins G, M and A to determine their isotype. Once entered into this prospective study the patients were followed for up to 16 months (mean 7.7 +/- 4.72 SD) with periodic determinations of APLA. Of the 500 patients with SLE, 88 had had thrombocytopenia, 25 had had hemolytic anemia, 25 had had both, and 362 had no history of these hemocytopenias. If we considered the odds ratio of these 362 patients for having high titer APLA as 1, patients with a history of thrombocytopenia, hemolytic anemia or both had significantly higher odds ratios of having APLA than did those without hemocytopenia. Patients with thrombocytopenia had significantly higher levels of IgG APLA, those with hemolytic anemia had significantly higher titers of IgM APLA and patients with both had significantly higher titers of both of these APLA isotypes, than did patients without hemocytopenias. A correlation between positive direct Coombs' tests and IgM APLA was also found. We conclude that APLA is associated with these hemocytopenias in SLE. This might be due to their interaction with negatively charged phospholipids in the cell walls of the respective cells.

Anemia, Hemolytic↗
PubMed1986

High incidence of subclavian dialysis catheter-related bacteremias.

This retrospective cohort study reviews the incidence of bacteremia in 48 patients undergoing hemodialysis using subclavian vein dialysis catheters (SDC) as temporary vascular access. Twelve (25%) of these patients had catheter-related bacteremia, and the most frequently isolated organisms were coagulase-negative staphylococci. Three patients developed right-sided endocarditis and one of them died due to pulmonary embolism. The presence of possible risk factors for SDC-related bacteremia, including duration of catheterization and number of hemodialysis procedures, were not statistically different when patients with and without bacteremia were compared, with the exception of a significantly lower incidence of bacteremia among those patients receiving antibiotic therapy at the time of catheter insertion. The use of resterilized catheters was not a risk factor. Specific guidelines for SDC insertion and care were established and followed, after which the infection frequency was reduced to 7.5% (1 episode per 45.5 patient-weeks of catheter use) in this high-risk population.

Catheters, Indwelling↗
PubMed1983

Detection of mycobacterial antigens in cerebrospinal fluid of patients with tuberculous meningitis by enzyme-linked immunosorbent assay.

Culture and identification of Mycobacterium tuberculosis in cerebrospinal fluid (CSF) of patients with tuberculous meningitis is slow, and prognosis depends on early diagnosis and treatment. An enzyme-linked immunosorbent assay with commercial BCG and anti-BCG was designed to detect mycobacterial antigens in human body fluids. Absorbance at 405 nm was measured and readings greater than or equal to 0.20 were considered positive. The readings were above 0.20 for four patients with confirmed tuberculous meningitis and nine of twelve patients with probable tuberculous meningitis. In all but one of ten patients with meningitis of other causes and in eleven control subjects the readings were below 0.20. The specificity of the test was 95% and its sensitivity 81.25%.

Antigens, Bacterial↗