ASEI es una revista científica de Fundación Huésped y la SADI que publica artículos sobre infectología, con foco en sida.
Fundación Huesped - Sociedad Argentina de Infectología
The editorial team of Revista ASEI would like to express its sincere gratitude to the 51 reviewers who dedicated their time and expertise to the journal's meticulous editorial process over the past twelve months. During this period, 34 submissions were received and evaluated, of which 20 were accepted and published, 2 were rejected, and 12 were still under review at the end of 2025. Of the 20 published submissions, 7 were original articles, 4 were brief communications, 8 were case reports, and 1 was a review article. In addition, 6 editorials and 3 supplements were published.
Communications from the Editorial Committee
Copyright (c) 2026 Comité Editorial https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es
Syphilis in Argentina: beyond the numbers
In recent years, syphilis has experienced a steady increase in Argentina, becoming one of the main challenges in the field of sexually transmitted infections (STIs). This upward trend, observed since the middle of the last decade, is reflected in the increase in notification rates, particularly among adolescents and young adults. According to data from Bulletin No. 42 on the Response to HIV and STIs in Argentina (1), the syphilis rate rose from 56.1 cases per 100,000 inhabitants in 2019 to 93 per 100,000 in 2024. The trend continued in 2025, with 46,613 confirmed cases, 71 % more than the median for the period 2020-2024 (2). It should be noted that the actual magnitude of the problem could be greater if underreporting of cases is taken into account. This scenario poses a specific health challenge. However, it is not enough to understand the phenomenon solely from the figures. Epidemiological data describe the magnitude of the problem, but do not fully explain its determinants. There is a less visible side to the STI epidemic, linked to biomedical, social, and cultural transformations that have changed sexual behaviors and perceptions of risk.
Copyright (c) 2026 Luciana Spadaccini https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es
The flu, ever the same and ever different, has once again shown us new paths
The influenza virus is a significant cause of morbidity and mortality worldwide. In addition to its well-known respiratory impact, multiple studies have shown that it can act as a trigger for major clinical events (AMI, stroke, diabetic decompensation, among others), which are equally preventable or mitigable by the available vaccine (1, 2). The emergence of a new variant (subclade) of the influenza A (H3N2) virus raised concerns among the medical community and the general population and prompted the publication of several documents by various scientific societies with the aim of providing clear information and practical tools, as well as including vaccination recommendations and specific considerations for both those who had not been vaccinated during the 2025 season and those who had received their vaccines in a timely manner (3). This editorial aims to contribute some reflections to the debate based on this scenario, improve understanding of the disease, learn about its global impact, and facilitate control strategies.
Copyright (c) 2026 Francisco Nacinovich, Pablo Bonvehí https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es
Inter-society document updating on dengue vaccination in Argentina
Dengue fever has become a serious public health problem in Argentina, with a progressive geographic expansion and a sustained increase in the number of cases. During the 2023-2024 season, more than 580,000 cases and 419 deaths were recorded, underscoring the urgent need to implement preventive strategies that complement vector control. Vaccination with TAK-003 represents a fundamental advance in dengue prevention in Argentina within the framework of a comprehensive disease control strategy.
Copyright (c) 2025 Octavia Bertachini, Pablo Bonvehí, Florencia Cahn, María Marta Contrini, Silvia González Ayala, Susana Lloveras, Alfonso Rodríguez Morales, Hebe Vázquez https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es
Dengue in the second trimester of pregnancy: a case of deciduitis, sub-amniotic hemorrhage, and fetal death
Dengue virus infections during pregnancy are on the increase, in line with the rise in cases in general population of this arboviral disease, which has the highest global burden. The maternal-fetal implications that dengue causes during pregnancy show heterogeneous evidence, with studies primarily focused on the third trimester and peripartum period, and few assessing associated risk factors or leading to anatomo-pathological studies. We describe a case of a pregnant woman with risk factors who aquired the infection during the second trimester, resulting in a fatal outcome for the fetus, and in whom an anatomo-pathological study of the ovular remains revealed deciduitis and sub-amniotic hemorrhage.
dengue, pregnancy, fetal death, placenta, hemorrhage
Copyright (c) 2026 Florencia Troglio, Javier Mesa, Gisela Wöhning, Daniel Rivas, Agustina Lacaze https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es
HIV-TB co-infection in Argentina: an unresolved public health issue
Tuberculosis (TB) and HIV co-infection represents one of the most complex challenges for public health in Latin America and the Caribbean, and Argentina is no exception. In a regional context where both epidemics have shown sustained growth since 2015, the interaction between TB and HIV continues to have a disproportionate impact, particularly on the most vulnerable populations.
Copyright (c) 2025 Omar Sued, Pablo Avedillo https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es
Antiretroviral treatment: what is coming
Most people living with HIV who can access and take oral anti-retroviral therapy (ART) can enjoy a normal life expectancy. However, stigma (daily reminder of status and fear of disclosure), forgetting and the inconvenience of daily pills remain barriers to successful ART for some people (1). There is significant interest in longer-acting treatment modalities and the first ever complete long-acting (2-monthly) intramuscular injectable regimen for people who are virally suppressed was licensed for use in 2021. It consists of a novel integrase strand transfer inhibitor (INSTI) called cabotegravir, and rilpivirine, a non-nucleoside reverse transcriptase inhibitor (NNRTI). People who take it prefer it to daily oral therapy with high rates of treatment satisfaction and the discontinuation rates are low. The efficacy has been shown to be similar to that of daily oral ART in both clinical trials and clinical practice. However, the genetic barrier to resistance is lower and when virological failure occurs, single or dual class resistance is very common (2). Providing 2-monthly injections is labour-intensive for clinicians and uptake has not been as high as expected, mainly because it is not presented as an option universally. Data of off-license use in people who are not-virally suppressed are limited.
Copyright (c) 2025 Chloe Orkin https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es
Beyond cardiopulmonary syndrome: Hantavirus-associated parainfectious encephalitis
Hantavirus is a viral zoonosis transmitted primarily by rodents and classically associated with cardiopulmonary syndrome. Parainfectious neurological manifestations are rare and poorly documented in the literature. We present the case of a previously healthy 34-year-old man who developed hantavirus-associated parainfectious encephalitis as a complication of hantavirus infection. With intensive support, hemodialysis, and plasmapheresis, the patient achieved a favorable outcome. This case represents an important epidemiological and clinical contribution, highlighting the need to consider neurological manifestations in patients with hantavirus infection.
Hantavirus, Encephalitis, Zoonoses, Plasmapheresis
Copyright (c) 2025 Maria Alejandrina Guerrera, Micaela Nomdedeu, María José Teruggi, Juan Ignacio Irigoitia, Anabella Erviti, Guillermo Bertoni, Ailén Fernández, Nadia Baldoni, Florencia Otermin, Juan Manuel Poggio https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es
Atypical mycobacterial infections of skin and soft tissue
Introduction: Nontuberculous mycobacteria (NTM) are environmental pathogens of increasing importance, responsible for skin and soft tissue infections (STIs), frequently associated with aesthetic or surgical procedures. Objectives: To describe the epidemiology, clinical characteristics, causative agents, diagnostic correlation and evolution of patients with STIs due to NTM in a High Complexity center. Materials and methods: A descriptive, observational, and retrospective study was conducted between January 2015 and December 2023, including adults with positive cultures for NTM in skin or soft tissue samples. Clinical, microbiological, and evolutionary data were collected through review of medical records. Results: Seventeen patients were identified (mean age 46 years, range 23–79; 65% female); three were immunocompromised (17.6%). The predominant clinical presentation was abscesses or nodules. Seven patients (41%) had a history of previous cosmetic procedures. The most frequently isolated species was M. abscessus (41%). The mean time to diagnosis was 40 days by culture and 5 days by PCR, the latter allowing for early initiation of treatment. Histological examination showed chronic inflammation in 10 patients, with granulomas in 4. Eight patients achieved complete resolution, two experienced relapses, and one died. Discussion: NTM infections are an emerging cause of skin and soft tissue infections, linked to the increase in cosmetic procedures. The implementation of molecular techniques allows for rapid diagnosis and timely treatment.
Nontuberculous mycobacteria, skin and soft tissue infections, aesthetic procedures.
Copyright (c) 2026 Jessica del Valle Molina, Corina Nemirovsky, Marisa del Lujan Sanchez, Laura Barcan, Luz Guadalupe Ibañez https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es
Update on hepatitis A vaccination in Argentina
This issue of ASEI presents an update on the topic prepared by the Vaccine Commission of the Argentine Society of Infectious Diseases (SADI). This update constitutes a fundamental tool for guiding clinical and public health decisions. The document reviews current indications, vaccination schedules, outbreak control strategies, and specificities in immunocompromised hosts. The Editorial Committee of the ASEI Journal encourages all healthcare teams to read, apply, and disseminate this document. Prevention, ultimately, remains the most effective tool for preserving the health of the population.
Copyright (c) 2025 Alejandra Gaiano, Andrea Mónaco, Martina De Prada, Mariana Golikow, Ana Ceballos, Gisela Calderón Arévalo, Gabriela Quintana , Silvia González Ayala https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es
Antibiotic therapy adequacy to PROA flowchart in community-acquired pneumonia in moderate care patients
Introduction: Antimicrobial Stewardship Programs (ASP) use evidence-based flowcharts to standardize infection management. Their implementation is rarely evaluated, limiting the validation of their impact. Objective: To evaluate the adequacy of antibiotic treatment according to the ASP flowchart in patients with community-acquired pneumonia (CAP) hospitalized in a moderate care unit at a tertiary care center. Methods: Observational, retrospective study (April-December 2024) was conducted on 50 immunocompetent patients ≥18 years of age with CAP hospitalized in a moderate care unit. Six adequacy indicators were analyzed (empirical selection, dosage, time to first dose < 4 hours, therapeutic adjustment, sequential therapy, and treatment duration), classified as optimal (>90%), intermediate (60-90%), or low (<60%). Results were expressed using descriptive statistics. Results: The mean age was 74.8 years, and 56% were male. Adequacy was low for four indicators: empirical selection (48%), therapeutic adjustment (23%), sequential therapy (55%), and treatment duration (16%). The time to first dose < 4 hours was appropriate at an intermediate level (66%). Correct dosage (96%) was the only indicator that reached an optimal level. Discussion: There are critical gaps in the antibiotic treatment adequacy in NAC associated with low adequacy of empirical antibiotic treatment and adjustment, delay and underuse of sequential therapy, and excessively prolonged treatments. Immediate interventions from the ASP Team are needed, focusing on training in empirical selection and therapeutic adjustment, mandatory reassessment protocols to counteract therapeutic inertia, support systems for sequential therapy and duration, and prospective audits with real-time feedback.
Copyright (c) 2025 Joaquín Ferreira Bacciarini, Angélica Benavente, Mariela Seguezza, Francisco Rodríguez De León, Paulina Brasó https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es
Infectious Endocarditis caused by Achromobacter xylosoxidans: Case report
Achromobacter xylosoxidans is a gram-negative, aerobic bacterium that causes invasive infections that are difficult to treat and have a high mortality rate. We present the case of a 75 years old man with a history of severe aortic stenosis admitted for acute pulmonary edema secondary to infective endocarditis, with positive blood and aortic valve cultures for said microorganism. Despite emergency clinical and surgical treatment, the patient died, highlighting the difficulty in managing endocarditis caused by rare microorganisms.
Achromobacter xylosoxidans, Infective Endocarditis, heart valves
Copyright (c) 2026 Lucia Guadalupe Guzmán, María Gabriela Peirotti, Evelyn Garro, Darío Conrado Quinodoz https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es
Pneumococcal vaccination: an ongoing challenge
Pneumonia and invasive pneumococcal disease are associated with high morbidity and mortality, underscoring the importance of vaccination as a preventive strategy. In Argentina, since 2017, a sequential vaccination schedule with the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23) has been recommended for adults aged 65 years and older, as well as for younger adults with comorbidities. The introduction of the 20-valent pneumococcal conjugate vaccine (PCV20) to replace the sequential scheme, has not only the purpose to simplify vaccination schedules but also improve adherence. The aim of this study was to describe the pneumococcal vaccination status among hospitalized adults in a Hospital in Buenos Aires, Argentina. An observational, descriptive, cross-sectional study was conducted among individuals aged 18 years and older with an indication for vaccination between November 2024 and February 2025. Patients were classified into three groups: complete vaccination (VC), incomplete vaccination (VI), and unvaccinated (NV). A total of 137 patients were analyzed; 56.9% were male, and the mean age was 74.3 years. Of them, 88.3% were older than 65 years; among younger patients, the predominant comorbidities were diabetes, smoking, HIV, and cancer. Overall, 46 patients (33.5%) had complete vaccination, 14 (10.2%) had an incomplete schedule, and 77 (56.2%) had not received any dose. None had received PCV20, as it was not available at our center during the study period. Our findings suggest that pneumococcal vaccination coverage remains suboptimal. It is essential to obtain data from local healthcare centers to develop targeted strategies to improve it.
Copyright (c) 2025 Marianela Paula López, Paula Castro, María Vanesa Durán https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es
Use of aminoglycosides in patients with intra-abdominal infections in a secondary acute care hospital
Aminoglycosides (AMG) are bactericidal, narrow-spectrum, and low-cost antibiotics, whose main limitation for clinical use is the risk of nephrotoxicity. The aim of this study was to characterize patients with intra-abdominal infections, describe the bacteriology and resistance profile, assess the frequency of acute kidney injury (AKI), and evaluate surgical outcomes. Materials and Methods: A prospective, observational study was conducted over one year, including hospitalized patients with intra-abdominal infections who received AMG therapy. AKI was defined as an increase in plasma creatinine of ≥0.3 mg/dL from baseline. Gentamicin serum levels and minimum inhibitory concentration (MIC) testing were performed. Results: A total of 126 patients were included, with a mean age of 51.6 years. The mean Karnofsky score was 89.8, and the mean Charlson comorbidity index was 1.8. The most frequent surgical diagnoses were appendicitis (38.9%), cholangitis (23%), and diverticulitis (13.5%). All patients received gentamicin, with a mean daily dose of 338.4 mg and a mean duration of 4.3 days. Escherichia coli was the most frequently isolated pathogen (68.8%), with 92.5% susceptibility to gentamicin. Clinical failure occurred in 15.1% of patients. AKI developed in 10.5% of cases, being mild in 91.7% and transient in 50%. Overall mortality was 3.2%. Patients who developed AKI were older and had higher Charlson and lower Karnofsky scores compared with controls (p<0.01). Conclusions: Aminoglycosides remain the antibiotic of choice in our setting, given their concordance with local antimicrobial susceptibility patterns. They showed a low rate of AKI and minimal therapeutic failure.
aminoglycosides, Gentamicin, Acute Kidney Injury, Anti-Bacterial Agents, Drug Resistance, Bacterial.
Copyright (c) 2026 Lucía Lamponi Tappatá, Diego Maurizi, Marisol Valle, Analía Álvarez, María Menichelli, Alex Schell, Matías Schulz, Marlene Bustelo, Naiara Paredes, Dina Pedersen, Celeste Martínez, Alejandra Oriani, Antonela Amusquibar, Pamela Dietrich, Mariano Echegorry, Alejandra Corso, Fernando Pasterán https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es
Giant exophytic mass as a rare presentation of Kaposi's sarcoma in a person living with HIV
Kaposi's sarcoma is the most common malignant tumor in people living with HIV. It typically affects the skin, mucous membranes, and lymph nodes, with the most frequent clinical presentation being erythematoviolaceous papules on the lower limbs, trunk, face, and oropharyngeal mucosa, with slow and centripetal dissemination. Visceral involvement may occur, with the gastrointestinal tract being the most frequent extracutaneous location. Evidence on atypical cutaneous presentations is limited in the literature. We present the case of a patient with a rare presentation of Kaposi's sarcoma, a giant exophytic mass resembling primary cutaneous lymphoma.
Copyright (c) 2026 Ana clara Irassar, Vanesa Dadon, Joaquín Cabral, Paola Staltari, Leandro Danze, Claudia G. Rodríguez, Ezequiel Córdova https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es
Lepromatous leprosy regarding a case diagnosed in Tierra del Fuego
Leprosy is a chronic, endemic and ubiquitous infectious disease. In 2000, the World Health Organization declared the elimination of leprosy as a global public health problem. Although the prevalence has decreased drastically since the introduction of multidrug therapy, there are still a considerable number of cases appearing in central African countries, India, China and Brazil (1, 2, 3). In Argentina, there are 400 cases per year under treatment, and a geographic focus on provinces in the northeast, northwest and center of the country, which concentrate approximately 70% of the cases (4, 5). The importance of reporting this case in Tierra del Fuego is due to the fact that it is not an endemic area of leprosy and since it is not a public health problem, it is difficult to diagnose because physicians do not suspect it as a possible differential diagnosis within dermatoses (1).
Leprosy, bacilloscopy multibacillary, Tierra del Fuego.
Copyright (c) 2025 Carla Cabrera, Mariela Toledo, Pablo Berenstein, Juan Manuel Márquez https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es
We present the case of a 58-year-old male patient from Santiago del Estero, a rural worker, who consulted for an inflammatory tumor involving skin and deep tissues of the right foot, which has an estimated evolution of two years. Microbiological cultures showed dry and cerebriform colonies, which were identified as Streptomyces sp. by MALDI TOF mass spectrometry, BD Bruker ® and whole genome sequencing. The condition was diagnosed as actinomycetoma. Imaging studies showed bone involvement, so treatment with trimethoprim-sulfamethoxazole and minocycline was initiated. However, due to the development of pulmonary tuberculosis, treatment was adjusted to rifampin, ethambutol, pyrazinamide, isoniazid, and trimethoprim-sulfamethoxazole, with favorable clinical outcome.
Streptomyces sp, actinomycetoma, micetoma
Copyright (c) 2026 Cinthya Indira Vargas Coello, Carolina Ugarte, Yamila Vallejos, María Sol Haim, Tomás Poklépovich, Nadina Caraballo, Noelia Costanzo, Mariela Schijman, María Emilia Villani https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es
Detection of viral agents in cerebrospinal fluid in pediatrics: 7 years of experience
The diagnosis of viral meningoencephalitis and encephalitis is a frequent challenge in pediatrics and the establishment of viral etiology by polymerase chain reaction (PCR) is important because it allows guiding treatment and avoiding the unnecessary use of antibiotics. We designed a retrospective study with the aim of describing the frequency of distribution of viral agents detected in cerebrospinal fluid (CSF) of children with suspected meningoencephalitis/viral encephalitis, assessing the percentage of HSV1-2 detection in second lumbar puncture when the first result was negative and correlating with the cytophysicochemical study. CSF samples collected in the period April 2017 to February 2024 from 590 hospitalized patients were analyzed with mutiplex PCR Meningitis/Encephalitis Panel (FilmArray, Biofire Diagnostics) and commercial techniques for HSV1-2. At least one viral agent was detected in 17% of the samples, with the highest frequency of Enterovirus: 10.8%, Human Herpes-6: 3.9% and HSV1: 1.9%. Patients with detectable PCR presented meningoencephalitis: 53% and encephalitis 19%. In 22% of cases they were associated with other pathologies. All second samples (40/590) tested for HSV1-2 were negative. Cytophysicochemical tests showed no differences between cases of herpetic and non-herpetic encephalitis.
Viral meningoencephalitis, Herpetic encephalitis, Cerebrospinal fluid, Herpes simplex virus, Viral diagnosis.
Copyright (c) 2025 Maria Juliana Palau, Natalia Treviño, Maria Paula Eguiguren, Lucía Zaccarello, Sebastián Oderiz, Cecilia Vescina https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es
Tuberculosis preventive treatment in people living with HIV in Argentina
Tuberculosis (TB) remains a major threat to people living with HIV (PLHIV) in Argentina. Despite robust scientific evidence supporting the implementation of TB preventive therapy (TPT) in this group, its adoption in clinical practice within the country remains limited. This article discusses the need to detect and treat TB infection in PLHIV in Argentina and proposes an operational strategy for the implementation of TPT in this population. It concludes that establishing a comprehensive system for screening, treatment, and information recording in PLHIV is essential.
Copyright (c) 2025 Fernando Biasutti https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es
Bacillary angiomatosis and Kaposi's sarcoma in skin lesion of HIV positive patient
Bacillary angiomatosis (BA) is a rare infectious disease, caused by bacteria of the genus Bartonella spp, transmitted by vectors such as fleas, lice and mosquitoes. It causes different clinical syndromes in humans. In patients with human immunodeficiency virus (HIV) infection with an LT CD4 + <100 cell/μL count, it is associated with the development of angiomatous lesions with neovascularization involving the skin and, with less frequency, mucous membranes, liver, spleen and bones. Kaposi's sarcoma (KS) is a neoplasm characterized by multifocal vascular hyperplasia of endothelial origin related to human herpes virus 8. It can also compromiso the skin, mucous membranes and viscera, with the epidemic variant being a marker disease of advanced HIV infection. The main clinical differential diagnosis for KS skin and mucosal lesions is the BA. Herein we present a patient with HIV/AIDS disease that developed BA and KS concomitantly in the same skin lesion.
Bacillary angiomatosis, Kaposi’s sarcoma, HIV, AIDS
Copyright (c) 2023 Graciana Lucía Cárdenas, Natalia Soledad Vittar, Javier José Ricart, Laura Gabriela Moreno Macías, Jorge Velázquez , Esteban Maronna, Marcelo Corti
Bronchial mucormycosis, an unusual finding on bronchoscopy
Mucormycosis is an infection caused by opportunistic fungi belonging to the order Mucorales. Since the SARS CoV 2 pandemic, warnings have been issued about the increase in the presentation of this infection. The presentation of tracheobronchial mucormycosis represents 37% of pulmonary involvement. We present the clinical case of a diabetic patient with severe pneumonia due to SARS VOC 2, with unfavorable evolution, who was taken to bronchoscopy and found whitish pseudomembranes obstructing the lumen of the left main bronchus, confirming histopathologically the presence of mucormycosis. A report of the present case is made to recognize the appearance of fungal infections in patients with poorly controlled diabetes and SARS COV 2 infection, who have a torpid evolution. The presence of white pseudomembranes should be an alarm sign to have this type of infections within the diagnostic possibilities.
Copyright (c) 2023 Natalia Fernanda Calderón Lopez, Diego Armando Oquendo Gahona, Giovani Lastra González, Jose Jovany Puentes
Chromoblastomycosis: a combination therapy approach
Chromoblastomycosis is a chronic and subcutaneous mycosis caused by various dematiaceous fungi, In Latin America, the most frequently found species are Fonsecaea pedrosoi and Cladophialophora carrionii. Treatment is a challenge because of the lack of response and recurrence in in some cases, especially in patients with extensive and chronic lesions. We report an individual with relapse of chromoblastomycosis (by Fonsecaea pedrosoi) in the right lower limb, who had undergone incomplete treatment with terbinafine and itraconazole. The patient responded favorably to retreatment with itraconazole and terbinafine combined with partial surgical resection of the lesion and skin grafting at the surgical site.
chromoblastomycosis, terbinafine, itraconazole. tropical wart syndrome
Copyright (c) 2023 Viviana Leiro, Patricia Fernández Pardal, Mauro Coringrato, Ornela Piñeiro, Esteban Maronna, Gabriela Santiso
Artificial intelligence in infectious diseases
We are in the midst of a true technological revolution in healthcare. Processes based upon artificial intelligence and machine learning are progressively touching all disciplinary areas, and its implementation in the field of infectious diseases is astonishing, accelerated by the COVID-19 pandemic. Today we have tools that can not only assist or carry on decision-making processes based upon guidelines or algorithms, but also modify its performance from the previously completed tasks. From optimization of the identification of resistant pathogens, selection of candidates for participating in clinical trials, the search of new antimicrobial therapeutic agents, the development of new vaccines, the prediction of future epidemics and pandemics, the clinical follow up of patients suffering infectious diseases up to the resource allocation in the management of an outbreak, are all current activities that can apply artificial intelligence in order to improve their final outcomes. This development has an exponential possibility of application, and is undoubtedly one of the main determinants that will shape medical activity in the future. Notwithstanding the maturation of this technology that is required for its definitive insertion in day-to-day healthcare activities, should be accompanied by definition of reference parameters, validation systems and regulatory guidelines that do not exist yet or are still in its initial stages.
Copyright (c) 2023 Waldo Belloso, Fernando Pasterán, Valeria Burgos, Sofía Díaz, Vitas Ciabis, Marcelo Risk
Phagotherapy: an emerging alternative in the antibiotic multiresistance era
The rising antimicrobial resistance associated with the crisis in new antibiotics production and the human and economic consequences of this phenomenon constitute a complex scenario that requires the urgent development of alternative antimicrobial strategies. Bacteriophages are viruses that infect and lyse bacteria. They have been known for over a century but in the last two decades, phage administration has gained popularity worldwide. There is an extensive body of preclinical and clinical evidence that positions phage therapy as one of the main tools for the treatment of difficult-to-treat infections. Although this is conceptually promising, its implementation is limited by the paucity of clinical data on safety and efficacy, obtained according to current scientific standards. This review describes the most relevant data on phage biology, pharmacokinetic and pharmacodynamic aspects known to date, regulatory issues, and the most relevant clinical results.
fagotherapy bacteriophage, phage, difficult-to-treat infections, antimicrobial resistance.
Analysis on the effects of the SARS-CoV-2 Pandemic in relation to voluntary HIV testing at a Public Hospital in Buenos Aires City
The emergence of SARS-COV-2 at the end of 2019 caused difficulties for the public health system to achieve the goals set by the WHO (World’s Health Organization) focused on the eradication of HIV, mainly in developing countries. With the purpose of evaluating the impact in our field, a public hospital in Ciudad Autónoma de Buenos Aires provided the information about the volunteers tested in the time span of January 2017 up until June 2022 according to the records from the main laboratory. The number of tests conducted during the pre-pandemic were double in comparison of the ones made during the pandemic. There were significant statistical differences in the average of monthly tests conducted, with a reduction of up to 60%. Even in the course of 2022, they stayed below the numbers before 2019. Regarding the prevalence of reactive serologies, they were similar to the ones from 2019 (2.4%). Considering the lack of verified diagnosis of HIV implies the progression to AIDS, vulnerability to opportunistic infections, exposure of other people to the infection, risk of life and perpetuation of the virus in the population, it is necessary to actively retake the fight against HIV.
COVID-19 and HIV. Serological testing. HIV prevalence.
Copyright (c) 2023 María Teresa Gabriela Rocculi
Carbapenem-resistant Enterobacterales: Epidemiological study of isolates in a public hospital in Santa Fe
Introduction: The incidence of carbapenem-resistant Enterobacterales (CRE) rose in the last decade, and especially during the COVID-19 pandemic. Objective: To identify the antimicrobial resistance profile, as well as the frequency and type of carbapenems that were present in CRE isolations in a tertiary care hospital. Materials and methods: Epidemiological, observational and retrospective study. It included CRE isolated in clinical samples during 2021 in a tertiary care hospital in Argentina. Incidences (isolations/patients-day), confidence intervals of 95% (CI 95%) and statistical comparisons were made with OpenEpi. Results: 348 CRE were isolated (11.9 isolations/1,000 patients-day, IC95% 10.7-13.2). Incidence correlated to COVID-19 cases (rho=0.874, p<0.001). Most isolations were from the Intensive Care Unit (76.4%) and the from respiratory samples (27.6%, n=96) and blood cultures (24.4%, n=92). The main isolated CRE was Klebsiella pneumoniae (71.4%, n=260), with a general carbapenem resistance of 53.4%. KPC was the main resistance mechanism (61.2%). Two double carbapenemase-producing Enterobacterales were isolated. Klebsiella pneumoniae presented a higher overall resistance rate to non-betalactam antibiotics (60.6% vs 38.5%, p<0.001). Among CRE, a higher colistin resistance rate was found in KPC isolations (44.6% vs 23.9%, p=0.001) and lower resistance to amikacin (23.9% vs 72.6%, p<0.001). Conclusion: The difficulty in the selection of antibiotic regimens for CRE forces the treating physicians to put emphasis on the knowledge of resistance mechanisms to optimize them.
Gisela Romina Muñoz Cena2Sección de Microbiología, Hospital Dr. JB Iturraspe (Santa Fe, Argentina)
Copyright (c) 2023 Maximiliano Gabriel Castro, Andrea Florencia Gómez Colussi2, Gisela Romina Muñoz Cena, Lucía Inés Ubriego, Macarena Vicino, Virginia Dotti, María Fernanda Argarañá
Syphilis, HIV and hepatitis B in the Mother-Child binomial
INTRODUCTION Perinatal infections can be transmitted to the fetus and newborn. Syphilis, HIV and Hepatitis B must be screened during pregnancy. OBJECTIVE To know incidence, prevalence and management of syphilis, HIV and hepatitis B in the mother/child pairing. Compare results with official statistics. MATERIALS AND METHODS Retrospective, descriptive and analytical study, through review of medical records from the Sanatorio la Cañada and Hospital Pasteur in Villa Maria, Cordoba. Period 12/01/2020 to 03/31/2021. RESULTS 870 pregnancies studied, 5.3% reactive syphilis serology and 1% HIV. Maternal syphilis incidence 52.87 per 1000 pregnancies, percentage of positivity 5.3%. 76.1% under 30 years old. 41% late diagnoses. 37% incomplete treatments. Congenital syphilis incidence 18.3 per 1000 live newborns. Percentage of maternal HIV posivity 0.68%. 66.7% under 30 years old. 100% underwent correct treatment and 77.7% undetectable viral load at delivery. 100% exposed newborns studied, all undetectable viral load at birth. No cases of Hepatitis B. CONCLUSION 6.3% of pregnant women presented at least one reactive serology, prevailing age under 30 years. Percentage of maternal syphilis posivity lower than published by province of Cordoba. Congenital syphilis incidence exceeded the provincial and national (18.3 vs 1.18 vs 1.14). Percentage of maternal HIV posivity exceeded provincial ones. No detected vertical transmission of HIV at birth. Hepatitis B prevalence lower than official data. Pregnant women diagnosed with HIV have more follow-up from the health system than those diagnosed with syphilis.
Vertical Infection Transmission; HIV, Congenital Syphilis; Hepatitis B
Copyright (c) 2023 Lucia Guadalupe Guzmán, Virginia Tavecchio, Laureano Fraga, María Soledad Frola, Darío Quinodoz
Educational intervention to improve ceftriaxone prescription in an emergency department
Objective: To evaluate the prevalence and appropriateness of ceftriaxone after an educational intervention in an emergency department. Methods: Quasi-experimental study, which included a consecutive sampling of unscheduled consultations of adult patients, during 2 months pre-intervention and post-intervention. The intervention consisted of training physicians to limit its indication only to specific clinical situations (meningitis, pelvic inflammatory disease, and acute abdomen). Retrospective data were used, with additional manual chart review, to validate appropriateness of antibiotic initiation and drug appropriateness. Descriptive and analytical statistics were used. Results: Among 28570 visits, 512 received ceftriaxone (1.79%; 95%CI 1.64-1.95), and only 60.54% were hospitalized. Regarding the before-after comparison, we observed a reduction in the rate of use (from 3.66% to 0.63%; p<0.001), the appropriateness in starting an antimicrobial was maintained (from 84.52% to 86.21%; p=0.778), and the appropriateness of ceftriaxone increased significantly (from 41.78% to 84.00% respectively; p<0.001). Additionally, hospital length of stay was reduced (median 6 to 5 days; p=0.014), with no difference in in-hospital mortality (19.44% vs 17.24%; p=0.691), nor in 30-day mortality (23.41% vs 18.96%; p=0.464). Conclusions: This intervention was effective. These findings represent a fundamental step in programs to optimize the use of hospital antimicrobials, aimed at reducing their overuse and consequent resistance.
Copyright (c) 2023 Maria Florencia Grande Ratti, Marisa Sanchez, Naldo Genoud, Facundo Arguello, Maria Sol Burokas, María Inés Staneloni, Corina Nemirovsky
Background: Dual therapy has emerged as a novel concept for HIV treatment. Thisstudy was aimed at comparing a nucleoside-sparing dual regimen consisting of ATV/r + RAL (DT) vs standard therapy of ATV/r + TDF/FTC (TT) among individuals failing first NNRTI-containing treatment. Methods: Randomized multicenter open-label pilot study. Primary outcome: proportion of subjects with plasma HIV-1 RNA below the limit of detection (<50 copies/mL) at 48 weeks (W48). Secondary outcomes: proportion of discontinuation due to adverse events (AEs), time until viral suppression, time until loss of virological response, development of integrase resistance mutations, and absolute change in CD4 counts. The primary outcome was analyzed using the FDA snapshot analysis. Results: Out of 57 participants screened, 34 were randomized to receive: DT (n: 18) or TT (n: 16). At W48, virological response was achieved in 67% (n: 12/18) of participants receiving DT and 88% (n: 14/16) receiving TT by FDA snapshot analysis (p = NS) and 73% and 93% by per-protocol analysis (p = NS). CD4 cell count median change from baseline to W48 was +119 and + 52 cell/μL in DT and TT, respectively. Four participants receiving DT and one TT presented virological failure at W48, with low pVL. One participant developed an integrase resistance mutation (155H) and suppressed later on TT. Conclusion: ATV/r+RAL as second-line therapy showed a trend to more frequent virological failure, compared to TT, although the study was unpowered to prove this difference. No major differences were seen in tolerance or toxicity. This study is registered with ClinicalTrials.gov, Number: NCT01829802
Copyright (c) 2023 María Inés Figueroa , Omar Sued, Carina Cesar, Patricia Patterson, Cleyton Yamamoto , Valeria Fink, Norma Luna, Antonio Camiro-Zúñiga, Ana Gun, Pedro Cahn
According to the World Health Organization (WHO), vaccines and safe drinking water are the two most important health strategies for disease prevention. Argentina has a national vaccination calendar (NVC) that includes free and compulsory vaccines. It went from being almost exclusively for children to offering vaccines for all stages of life. When we say that the vaccines included in the NVC are free and mandatory, we are referring to a right but also to an obligation, because vaccines not only protect those who receive them but also those around them. Vaccines are solidarity-based. The fact that they are free of charge introduces the concept of equity; anyone who has an indication can receive them. Vaccine-preventable diseases are serious and can lead to severe complications, sequelae and even death. But vaccines are also victims of their own success. Thanks to them, some diseases are controlled and are very infrequent. This leads to a low perception of the risk of disease in the population and in the health team, generating a decrease in vaccination coverage, which could result in the re-emergence of previously-controlled pathologies. It is important to clarify that eliminating a disease is not the same as eradicating it. Eliminating a disease implies that the circulation of the infectious agent that produces it is interrupted. This is achieved if there are good vaccination coverages, i.e. if all the people who should be vaccinated are indeed vaccinated (or at least a large percentage). If vaccination coverage decreases, diseases return. In other words, we must continue vaccinating to sustain the elimination status. In the case of disease eradication, the infectious agent is no longer circulating anywhere on the planet and vaccination is no longer necessary. The classic example of an eradicated disease is human smallpox. Recently, thousands of cases of monkeypox have been reported, produced by a virus of the same family as the one that caused human smallpox, but it is a different disease. When we talk about vaccines, it is always tempting to refer to the myths surrounding this topic, but this is not a good strategy from a communication point of view. When we want to disprove a myth, we can inadvertently install it, and that could lead to serious consequences. It is more effective to provide a positive message without referring to the myth, at least not directly. In Argentina and in the Americas region, the vast majority of people adhere to vaccination programs and have their vaccination schedules completed or, at least, started. There is a very small minority group of people (the so- called “antivaccine”) but very “noisy” in forums and social networks. This group is resistant to scientific evidence, i.e. no matter how many papers or publications we show them, nothing is going to make them change their minds. But we said that the majority of the population adheres to vaccination and, at the other extreme, there is this group of people who, regardless of what we tell them, are not going to get vaccinated. In the middle of these two groups there are people who have genuine doubts regarding vaccines and, in this sense, it is essential that, as health professionals, we can listen to them, with empathy and without judgment, to answer each of these doubts and provide an evidence- based response. It is in this group of people who doubt about all or some of the vaccines where we have to put all the energy, in order to answer their questions and concerns that often lie in the lack of information or false information circulating in the media, social networks and WhatsApp groups. To talk about pro-vaccine and anti-vaccine is a false dichotomy because scientific evidence is one, it is not subjective, it is not a matter of taste or opinion. No one would think of setting up a debate on television discussing the usefulness of drinking water with a graph reading “Drinking water, yes or no: the debate”. However, this has happened more than once in our country. Between 2009 and 2019, there was a 10-point drop in vaccination coverage in our country and in the region of the Americas. Later, the pandemic and the restrictions it demanded caused, among other consequences, an abrupt drop in coverage: for most vaccines, coverage did not reach 80%. This implies a public health problem due to the risk of reintroduction of previously-controlled diseases. The lack of recommendation by health personnel is one of the factors that may affect adequate vaccination coverage in the population and the number of doses administered. For this reason, it is essential that the entire health team work together to initiate or complete vaccination schedules. It is important to remember that vaccination schedules initiated should be completed, not restarted. The most important thing we can do as health professionals is always to listen and explain, and not to point fingers or judge. If a family that has not vaccinated their children so far comes to the clinic or the vaccination center because they have decided to start, we should welcome them with open arms and tell them that it is never too late. Sources: 1. Argentine Society of Vaccinology and Epidemiology (SAVE) 2. Argentine Society of Infectious Diseases (SADI) 3. PAHO 4. Ministry of Health of Argentina