Browsing by Author "Rabagliati Borie, Ricardo Miguel"
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- ItemActualizaciones en el manejo general de pacientes postrasplante hepático y de sus complicaciones más frecuentes(2024) Díaz Piga, Luis Antonio; Villalón Friedrich, Alejandro Andrés; Ochoa, Gabriela; García Castillo, Sergio Adrián Nicolas; Severino Cuevas, Nicolás Felipe; Ayares Campos, Gustavo Ignacio; Idalsoaga Ferrer, Francisco Javier; Dib Marambio, Martín Javier; Briceño Valenzuela, Eduardo Andrés; Viñuela Fawaz, Eduardo Andrés; Martínez Castillo, Jorge Arturo; Jarufe Cassis, Nicolás Patricio; Rabagliati Borie, Ricardo Miguel; Meneses Quiroz, Luis Andrés; Muñoz Schuffenegger, Pablo; Vargas Domínguez, José Ignacio; Espino Espino, Alberto Antonio; Vera Alarcón, María Magdalena; Benítez Gajardo, Carlos Esteban; Wolff Rojas, Rodrigo Mauricio; Norero Muñoz, Blanca Gabriela; Barrera Álvarez, Francisco Benjamín; Soza Ried, Alejandro; Arrese Jiménez, Marco Antonio; Arab Verdugo, Juan PabloLiver transplantation (LT) is a cost-effective therapy for advanced liver disease. Although LT significantly improves long-term survival, it requires strict control of immunosuppressants and their potential complications. Several available immunosuppressive drugs include glucocorticoids, calcineurin inhibitors, mycophenolate, mTOR inhibitors, and anti-CD25 antibodies. These drugs act particularly in T lymphocytes, depleting them, deviating their traffic, or blocking their response pathways. The main complications after LT include renal failure and infectious, immunological, biliary, vascular adverse events, metabolic, cardiovascular, and neoplastic diseases, especially during the first months. Bacteria, viruses, and fungi can cause infections in these patients. Prophylaxis against Herpes simplex virus, Varicella zoster virus, Cytomegalovirus, Pneumocystis jirovecii, Candida spp., and Aspergillus spp. should be considered according to the presence of risk factors. Among immunological complications, acute cellular rejection is common (30% of LT) but usually responds to immunosuppressive escalation. Also, chronic rejection appears in 3-17% of LT, but only half of the recipients respond to increased immunosuppressants. Appropriate treatment of the underlying etiology is essential, especially in autoimmune diseases, hepatitis B and C virus infection. Lifestyle changes must be encouraged in all patients, and alcohol consumption avoided (especially in alcohol use disorder). Due to the increased risk of cancer, neoplasms must be actively monitored, as well as osteoporosis and other metabolic disorders such as diabetes and cardiovascular disease.
- ItemConsenso sobre riesgo de complicaciones infecciosas en pacientes usuarios de medicamentos biológicos seleccionados. Parte II: Guía clínica chilena de Prevención de Infecciones Asociadas al Uso de Terapias Biológicas (PREVITEB)(2019) Cerón Araya, Inés María; Vizcaya Altamirano, María Cecilia; Gambra, Pilar; Ferres Garrido, Marcela Viviana; Bidart, Teresa; Lépez Quizhpi,Tania Lorena; Acuña, María Paz; Álvarez, Ana María; Zubieta, Marcela; Durán, Luisa; Rabagliati Borie, Ricardo MiguelThe use of biological therapies has meant a great improvement in the management of several conditions like autoimmune, neoplastic or others diseases. Although its use has implied significant improvements in the prognosis of these diseases, it is not exempt from complications: infectious diseases as one of them. The objective of this consensus was to evaluate, from an infectious viewpoint, the safeness of the most frequently used biological therapies and give recommendations for the prevention of infections in patients treated with these drugs. These recommendations were based on the highest quality evidence available for the selected biologics. The consensus counts of 2 manuscripts. This second part is a guideline that details these recommendations through screening strategies, prophylactic therapies and vaccines indications for bacterial, mycobacterial, viral, fungal and parasitic infections, both for adults and children.
- ItemConsenso sobre riesgo de complicaciones infecciosas en pacientes usuarios de medicamentos biológicos seleccionados. Primera parte(2019) Cerón Araya, Inés María; Gambra, Pilar; Vizcaya Altamirano, María Cecilia; Ferrés Garrido, Marcela Viviana; Bidart, Teresa; López Quizhpi, Tania Lorena; Acuña, M. Paz; Álvarez, Ana M.; Zubieta, Marcela; Rabello, Marcela; Iruretagoyena Bruce, Mirentxu Inés; Rabagliati Borie, Ricardo MiguelThe use of biological therapies has meant a great improvement in the management of several conditions like autoimmune, neoplastic or others diseases. Although its use has implied significant improvements in the prognosis of these diseases, it is not exempt from complications: infectious diseases as one of them. The objective of this consensus was to evaluate, from an infectious viewpoint, the safeness of the most frequently used biological therapies and give recommendations for the prevention of infections in patients treated with these drugs. These recommendations were based on the highest quality evidence available for the selected biologics. The consensus counts of two manuscripts. This first part details the risks of developing infectious complications depending on the type of biological used for a certain pathology. This evaluation included a broad search in MEDLINE and Epistemonikos of systematic reviews and meta-analyzes of controlled clinical trials and case- control examining post-treatment infections with anti-TNF alpha, anti-CD20, anti-CD52, CTLA4-Ig and anti-integrins. The research was complemented by a review of: multicentre cohorts of biological users, the MMWR of the CDC, Atlanta, U.S.A., and national registers and scientific societies in which infectious complications derived from the use of biological therapies were mentioned.
- ItemEndemic Scrub Typhus-like Illness, Chile(Centers for Disease Control an Prevention, 2011) Balcells Marty, María Elvira; Rabagliati Borie, Ricardo Miguel; García Cañete, Patricia Del Carmen; Poggi Mayorga, Helena Loreto; Oddo Benavides, Carlos David; Concha Rogazy, Marcela Andrea; Abarca Villaseca, Katia; Jiang, Ju; Kelly, Daryl J.; Richards, Allen L.; Fuerst, Paul A.We report a case of scrub typhus in a 54-year-old man who was bitten by several terrestrial leeches during a trip to Chiloe Island in southern Chile in 2006. A molecular sample, identified as related to Orientia tsutsugamushi based on the sequence of the 16S rRNA gene, was obtained from a biopsy specimen of the eschar on the patient's leg. Serologic analysis showed immunoglobulin G conversion against O. tsutsugamushi whole cell antigen. This case and its associated molecular analyses suggest that an Orientia-like agent is present in the Western Hemisphere that can produce scrub typhus-like illness. The molecular analysis suggests that the infectious agent is closely related, although not identical, to members of the Orientia sp. from Asia.
- ItemInfluenza pandémica A (H1N1) 2009: epidemiología, características clínicas y diferencias con influenza estacional en Chile(Sociedad Chilena de Infectología, 2011) Rabagliati Borie, Ricardo Miguel; Siri Zunino, Leonardo; Pérez Cortés, Carlos Miguel; Labarca L., Jaime; Ferrés, MarcelaLa pandemia de inluenza A (H1N1) 2009 generó preguntas sobre sus diferencias con influenza estacional. Objetivos: Describir las características de influenza pandémica y comparar con influenza estacional. Pacientes y Métodos: Estudio descriptivo de casos confirmados de influenza pandémica en adultos internados en el Hospital Clínico de la Pontificia Universidad Católica entre mayo y julio de 2009, comparado con 95 casos históricos de influenza estacional. Resultados: 54 pacientes con influenza pandémica, 51,9% género masculino, edad 52,8 ± 19,5 años; 79,6% presentaban co-morbilidades; 16,7% inmunocomprometidos, 7,4% mujeres embarazadas, 25,9% de adquisición nosocomial, 31,5% requirió cuidados intensivos/intermedios. Se diagnosticó neumonía en 37% y la mortalidad global fue 3,7%. En la comparación con inluenza estacional, la pandémica afectó menos pacientes > de 65 años (31,5 vs 68%, p < 0,0001), dobló los casos con adquisición nosocomial y hubo más casos de neumonía y muertes. Conclusiones: La infección por inluenza pandémica afectó a un grupo de menor edad y generó mayor transmisión nosocomial, neumonía y muerte que la inluenza estacional.
- ItemNeumonía cavitada por Rhodococcus equi en paciente inmunocomprometido no infectado por virus de inmunodeficiencia humana: caso clínico y revisión(Sociedad Chilena de Infectología, 2005) Rabagliati Borie, Ricardo Miguel; Morales Soto, Arturo Javier; Baudrand Biggs, René; Jorquera Arévalo, Jorge Antonio; Oddo Benavides, David; García Cañete, Patricia; Carmona P., M. Cecilia; Cisternas Martínez, Marcela Carolina; Huete Garín, AlvaroRhodococcus equi, es un bacilo grampositivo intracelular que causa infecciones mayoritariamente en pacientes inmunodeprimidos. Reportamos el caso de una mujer de 52 años, en tratamiento de lupus eritematoso sistémico, con historia progresiva de 10 meses de evolución caracterizada por tos, disnea progresiva, expectoración muco-purulenta, ocasionalmente hemoptoica, fiebre intermitente, y pérdida de peso del 10%. Tuvo respuesta parcial a diversos cursos de tratamiento antimicrobiano y el seguimiento radiológico evidenció la aparición de múltiples focos de consolidación bilaterales, algunos de ellos nodulares. El estudio microbiológico de un lavado broncoalveolar y de una biopsia pulmonar percutánea permitió la identificación de R. equi y la histología de la biopsia pulmonar fue compatible. Recibió tratamiento antimicrobiano bi-asociado prolongado con buena respuesta clínica y radiológica. Se debe considerar este agente en el estudio de pacientes inmunocomprometidos que cursan con neumonías de evolución prolongada.
- ItemParte I. Requerimientos básicos de infectología para hospitales que atienden pacientes hemato-oncológicos: ambiente hospitalario, protocolos diagnósticos y arsenal terapéutico. Fundamentación(Sociedad Chilena de Infectología, 2019) Rabagliati Borie, Ricardo Miguel; Santolaya, María Elena; Ferrés, Marcela; Rabello, Marcela; Catalán, PaulaLa atención de pacientes con cáncer, incluyendo los receptores de trasplantes de precursores hematopoyéticos, plantea numerosos desafíos para los hospitales que deben proveer ambientes seguros, en que se logre aminorar al máximo posible la exposición a patógenos que generan morbilidad y mortalidad. Al mismo tiempo deben contar con protocolos establecidos que permitan realizar un estudio racional de las posibles etiologías infecciosas que pueden presentar estos pacientes. A su vez, deben asegurar la existencia de un arsenal terapéutico adecuado, junto a algoritmos de tratamiento oportuno, actualizado según guías consensuadas y efectivo según la infección sospechada o confirmada. En este artículo se introducen algunos de los argumentos que sustentan estos requerimientos que luego se desarrollan en tres artículos sucesivos dedicados al ambiente hospitalario, protocolos diagnósticos y arsenal terapéutico.
- ItemRates of Hospital-Acquired Influenza Due to the Pandemic H1N1 Virus in 2009, Compared with Seasonal Influenza(Cambridge University Press, 2011) Rabagliati Borie, Ricardo Miguel; Labarca L., Jaime; Siri Zunino, Leonardo; Pérez Cortés, Carlos Miguel; Ferrés, Marcela
- ItemReconocimiento de influenza-A como etiología de síndrome febril e insuficiencia respiratoria en adultos hospitalizados durante brote en la comunidad(2004) Rabagliati Borie, Ricardo Miguel; Benítez Gómez, Rosana; Fernández Montenegro, María Alicia; Gaete Gutiérrez, Pablo Antonio; Guzmán Durán, Ana María; García Cañete, Patricia; Ferrés, Marcela; Pérez Cortés, Carlos Miguel; Labarca L., JaimeBackground: Influenza-A (IA) occurs every winter, is mostly observed among outpatients. Aim: To describe the clinical and epidemiological characteristics of cases that required hospital admission during an outbreak in Chile in 1999. Patients and methods: Adults subjects, with Influenza A confirmed by antigen detection test, hospitalized in the clinical hospital of the «Hospital Clínico de la Universidad Católica de Chile» between May and June, with fever or respiratory symptoms were studied. A special record was designed to register clinical, microbiological and therapeutic data. Results: Fifty five cases, 26 males, aged 15 to 91 years, were studied. Eighty four percent had chronic concomitant diseases and 9.1% were immunosuppressed. Clinical findings were fever in 87.3%, asthenia in 83.6%, cough in 93.6%, abnormal pulmonary signs in 69%, an elevated C-reactive protein (mean value of 11.6 ± 7.1 mg/dL) and acute respiratory insufficiency in 54.5%. Cases were isolated in cohort or individual rooms and 38.2% were admitted to intensive or intermediate care units. Amantadine was prescribed to 52 patients and was well tolerated. Thirty three percent of cases developed pneumonia. These subjects were older, had more dyspnea and respiratory insufficiency than patients without pneumonia. Conclusions: IA should be borne in mind when dealing with hospitalized adults, during epidemic outbreaks in the community. The clinical picture can resemble a serious bacterial infection. An early diagnosis allows the use of specific treatments, to decrease the risk of nosocomial spread and to avoid unnecessary use of antibiotics.
- ItemReduced Immune Response to Inactivated Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine in a Cohort of Immunocompromised Patients in Chile(Oxford University Press for the Infectious Diseases Society of America, 2022) Balcells Marty, María Elvira; Le Corre Pérez, Monique Nicole; Durán Santa Cruz, Josefina Gracia; Ceballos Valdivielso, María Elena Andrea; Vizcaya Altamirano, María Cecilia; Mondaca Contreras, Sebastián Patricio; Dib Marambio, Martin Javier; Rabagliati Borie, Ricardo Miguel; Sarmiento Maldonado, Mauricio; Burgos Cañete, Paula Isabel; Espinoza Sepúlveda, Manuel Antonio; Ferres Garrido, Marcela Viviana; Martínez Valdebenito, Constanza Pamela; Ruiz-Tagle Seguel, Cinthya Grace; Ortiz Koh, Catalina Alejandra; Ross Pérez, Patricio Daniel; Budnik Bitran, Sigall; Solari Gajardo, Sandra; Vizcaya Vergara, María De Los Ángeles; Lembach, Hanns; Berríos Rojas, Roslye; Melo González, Felipe; Rios Raggio, Mariana; Kalergis Parra, Alexis Mikes; Bueno Ramírez, Susan Marcela; Nervi Nattero, BrunoBackground Inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines have been widely implemented in low- and middle-income countries. However, immunogenicity in immunocompromised patients has not been established. Herein, we aimed to evaluate immune response to CoronaVac vaccine in these patients. Methods This prospective cohort study included 193 participants with 5 different immunocompromising conditions and 67 controls, receiving 2 doses of CoronaVac 8-12 weeks before enrollment. The study was conducted between May and August 2021, at Red de Salud UC-CHRISTUS, Santiago, Chile. Neutralizing antibody (NAb) positivity, total anti-SARS-CoV-2 immunoglobulin G antibody (TAb) concentrations, and T-cell responses were determined. Results NAb positivity and median neutralizing activity were 83.1% and 51.2% for the control group versus 20.6% and 5.7% (both P < .001) in the solid organ transplant group, 41.5% and 19.2% (both P < .0001) in the autoimmune rheumatic diseases group, 43.3% (P < .001) and 21.4% (PP = .001) in the cancer with solid tumors group, 45.5% and 28.7% (both P < .001) in the human immunodeficiency virus (HIV) infection group, 64.3% and 56.6% (both differences not significant) in the hematopoietic stem cell transplant group, respectively. TAb seropositivity was also lower for the solid organ transplant (20.6%; P < .0001), rheumatic diseases (61%; P < .001), and HIV groups (70.9%; P = .003), compared with the control group (92.3%). On the other hand, the number of interferon gamma spot-forming T cells specific for SARS-CoV-2 tended to be lower in all immunocompromising conditions but did not differ significantly between groups. Conclusions Diverse immunocompromising conditions markedly reduce the humoral response to CoronaVac vaccine. These findings suggest that a boosting vaccination strategy should be considered in these vulnerable patients.
- ItemUtilidad de la reacción de polimerasa en cadena en tiempo real en el diagnóstico de infecciones por virus respiratorio sincicial en adultos(Sociedad Chilena de Infectología, 2007) Rabagliati Borie, Ricardo Miguel; Serri Venegas, Michel André; Montecinos Perret, Luisa Paola; Azócar Azócar, Teresa Del Carmen; Ferrés, MarcelaIntroducción: Las infecciones respiratorias virales (IRV) son causa importante de morbilidad en adultos. Virus respiratorio sincicial (VRS) causa hasta 20% de las IRV en esta edad; sin embargo, su diagnóstico es subestimado debido a una menor sensibilidad de las técnicas diagnosticas convencionales (IF y ELISA). Objetivos: Evaluar el impacto del uso de reacción de la polimerasa en cadena en tiempo real (TR-RPC en tiempo real) en el diagnóstico de IRV por VRS en adultos y caracterizar su perfil clínico. Pacientes y Métodos: Durante ocho semanas del año 2005, los adultos hospitalizados en Hospital Clínico de la Universidad Católica con sospecha de IRV, e IFD negativa para VRS, FLU-A, -B, paraFLU-1, 2, 3 y ADV de muestra de hisopado nasofaríngeo, fueron sometidos a detección de VRS por TR-RPC en tiempo real. Se confeccionó una base de datos con los antecedentes clínicos, laboratorio y evolución de cada paciente. Resultados: De 114 pacientes con IFD negativa en 17 (14,9%) se detectó VRS. Fiebre, congestión faríngea, tos y signos de obstrucción bronquial, configuraron en más de 80% de los casos el perfil clínico de los pacientes. Treinta por ciento presentaba enfermedad crónica y 47% eran inmunocomprometidos. Tres de 17 (18%) presentaron descompensación de la enfermedad de base y 1/17 (6%) requirió ventilación mecánica. No hubo mortalidad asociada. Conclusiones: El uso de TR-RPC en tiempo real permitió duplicar la detección de infecciones por VRS en adultos hospitalizados respecto a las diagnosticadas por IFD. Se recomienda considerar el empleo la técnica de TR-RPC en tiempo real en aquellos pacientes con sospecha clínica de VRS durante la temporada de VRS y estudio viro lógico negativo por métodos convencionales.