aria alvarez
Post on 22-Feb-2018
225 Views
Preview:
TRANSCRIPT
-
7/24/2019 aria Alvarez
1/58
"#$%&'(#)*+ ,#-&*./),)%+0*#)%' +1%$+.
23)/),'4$# &+1*')+.5
"#$% &'$ ($#)$ *+,$#-. /$+0$
1-2$ 3'45$5 5- 6'2-789+9:)$;-#,4749 5- /-54$8#)$
48$+ ;$' 1?$' 5- "49=
;$'@$:9ABC4+- DEFG
-
7/24/2019 aria Alvarez
2/58
60('&%+)1*+ 7#. %#0+
809&*1+ :+;)+< B$5$ 5)$ 0$H9# IJ '4K9= 79' 7L'7-#
;9M#-,45$ 7L'7-# 4'2$'@+N OEP
"#$%&'(#)*+ =#-&*.#-,$+-'8- H ?'$ 790>+47$74Q'
2#-7?-'8-
RR& =- -=@0$ S ->4=9549= 5- IT -' >-#4959 5- UV
/>/?@/"A686"=/ABC:D@6A8A+$E+ *0('&%+)%# 7# 0'&-*0'&%+.*7+7 #) #. (+1*#)%# 1') 1F)1#&G
W-=>9'=$M4+45$5 5- 8959 -+ -X?4>9 0Y5479 X?- $@-'5- '4K9=
-
7/24/2019 aria Alvarez
3/58
>+)#H' #E%F)7+& 7# "=
& 4'4749= 5- +$ 5Y7$5$ 5-+ OE +$ 8-#$>4$ $'@M4Q@7$ -0>)#47$ >#-79. #-=?+8Q -' ?'$40>9#8$'8- 54=04'?74Q' 5- +$ 09#8$+45$5 >9# 4'2-7749'-= M$78-#4$'$= -=>-74$+0-'8- >9#Z#$0[A\ 5- ]E $ ^ 5- _EP%
Z-'8$0474'$` B$#M-'474+4'$%
;7C40>a ;%% ! #$%& ' ()*+IJKILMNO48$+$#4$ +$ 09#8$+45$5 -= 5- $>#9g40$5$0-'8- ]%_P!"#$%$% '() *+,-$% ./012234522006 2//0
-
7/24/2019 aria Alvarez
4/58
8U'E NPVJP
R$ >-+)7?+$ eV :$'$ 7?$8#9 h=7$#=
;$++H W45- -= +$ >#40-#$0?f-# -' ,4$f$# $+ -=>$749
-' -+ 8#$'=M9#5$59#BC$++-':-#%
;- -=8#-'$ +$ =-#4- 5- Vi4'2$'@+ j/+$.$ ;Y=$09k X?-C$=8$ -+ 5)$ 5- C9H >-#=4=8-%
;- +$'.$' -' e?#9>$ +9=8-+Y29'9= 0Q,4+-=
B$- -+ 0?#9 5- d-#+)'
I$7- +$ ?'4Q' -?#9>-$
-
7/24/2019 aria Alvarez
5/58
"Y7$5$ lEm]E
B+)'479= #-79'97-' X?- ?'$ :#$' 7$'@5$5 5- >$74-'8-= 79' IT =4:?-' ?'7?#=9 =4' 4'745-'8-= H >95#)$' '9 #-X?-#4# C9=>48$+4.$74Q' >#9+9':$5$ >$#$-+ 8#$8$04-'89 &d
"-=$##9++9 5- 4',-=@:$749'-= 5-=@'$5$= $ >#-5-74# -+ 7?#=9 7+)'479 X?-
=-:?4#L' +9= ->4=9549= 5- IT
B&VeZhW6n&B6hI "e W6e;Zh
8:BC W8XC
-
7/24/2019 aria Alvarez
6/58
=+1%'E + *)1.$*& #) .+E 1+%#Y'&*Z+1*')#E 7#&*#EY'
/E(#1[\1'E 7#.(+1*#)%#9 5- BL'7-#o e=8$59 5- +$ -'2-#0-5$5
/E(#1[\1'E 7#.%&+%+0*#)%'
o V4>9 H @-0>9 5- UV
/E(#1[\1'E 7#. /(*E'7*'7# "=
o B?$'p$ 5- +$ q-M#-o 98-'=4Q'o (?79=4@=o
-
7/24/2019 aria Alvarez
7/58
-
7/24/2019 aria Alvarez
8/58
/),'4$#
>+)#H' #E%F)7+&
]+1*#)%# 1') "=
^'E(*%+.*Z+1*_)
8BW #0([&*1' #G`G
>+)#H' +1%$+.
/),'4$# &+1*')+.
-
7/24/2019 aria Alvarez
9/58
/),)%+0*#)%' +1%$+. 7# .+ "= a6b
8(.*1+& 0'7#.'E 7# (*11*_) 7# &*#EY' 7# 6W6
>+)#H' +0-$.+%'&*' #) "=W?
65-'@q7$# 6'2-7749'-= d$78-#4$'$= 6',$=9#$=
&>+47$# 095-+9= 5- >#-54774Q' 5- =->=4= =-,-#$
"4$:'9=@79 -@9+Q:479
6'79#>9#$74Q' 5- '?-,$= C-##$04-'8$= 54$:'Q=@7$=
d49+9:)$ 09+-7?+$# 60>$789 5- +$= 4'2-7749'-= #-=>4#$89#4$= ,4#$+-= -' +$ -,9+?74Q' 5- -=89=
>$74-'8-=
"4$:'Q=@79 047#9M49+Q:479 09+-7?+$# >$#$ $,$'.$# -' -+ 54$:'Q=@79 5-=->=4=%
-
7/24/2019 aria Alvarez
10/58
>'7#.'E 7# (*11*_) 7# &*#EY' 7# "=`+.*7+7'E #) +7$.%'E
I-?8#9>-'4$ 2-M#4+ 5- d$f9 W4-=:9[ITdW\%
0-&.12 '3) 7%-8 9,:$%, ($# .;41230.523046 .$74-'8-= 7$8-:9#4.$59= 5- ITdW%
B90>+47$749'-= =9'^5- _P H 09#8$+45$5 -= ^ $ DP4&-56)/578 '6 $: +>1 = *>?, @,-A> 2;1;.2$$)5 ?# )6 -&G% = *+,-$% 4
-
7/24/2019 aria Alvarez
11/58
?#Y.+ 7# B+.1'c
B+.1'c X8d e*#Y#. ?fd =*)-#&Y ?d #% +.< ?*Eg $==-==0-'8 4' 7$'7-# >$@-'8= t48C 2-,-# $'5 '-?8#9>-'4$N&>#9=>-7@,-` 8t9A7-'8-# ,$+45$@9' 92 $ >#-547@9' #?+-% 1 B+4' h'79+ FENsFSAsDD` F]]D
-
7/24/2019 aria Alvarez
12/58
]$)%+H# 0Fh*0'< MQL ($)%+H# i MI *)7*1+ $) -+H'&*#EY' 7# 1'0(.*1+1*')#E 097*1+E
>8eAA e1'&*)Y ejE%#0BS# >$.;)+;')+. 8EE'1*+;') ,'& e$(('&;`# A+ *) A+)1#&
67#);,j ]+;#)%E k*%S A+)1#& +)7 =#-&*.# "#$%&'(#)*+
:'l ?*Eg ', >#7*1+. A'0(.*1+;')E
= *>?, @,-A> .41C/C45C/3.6 2///H"IIA%: *+%$ *+,-$%.21333530/ 2//;
J+$K+:A>AL?-+ R .01;P35;4C6 2//P
H"IIA%: *+%$ *+,-$% .014;.54;062//4JA,L !A,L ($# = .01C;5CP6 2/./
H"IIA%: *+%$ *+,-$% .
-
7/24/2019 aria Alvarez
13/58
@$*+E 6fe8 $(7+%# MPIP>+)#H' 80-$.+%'&*' 7# "=
A+%#Y'&*Z+1*_) 7# &*#EY' E#Ym) >8eAAG WV6
]+1*#)%#E 7# W+H' &*#EY'n >8eAA o MI (%'E WV6I-?8#9>-'4$ M#-,- 5?#$74Q'
I9 -g4=8-'74$ 5- 79A09#M4+45$5-=
B+)'47$0-'8- -=8$M+-=
A+%#Y'&*Z+1*_) 7# &*#EY' *)7*1+&+< 8V66V4>9 5- 8#$8$04-'89 $'@M4Q@79 -0>)#479 $ ?=$# C?8:V6p
R?:$# 5- 8#$8$04-'89 +0-$.+%'&*' $ S'E(*%+.*Z+7'
"?#$74Q' 5-+ 8#$8$04-'89
]+1*#)%#E 1') "=W? dE#.#11*')+7'E 1$*7+7'E+0#)%# E') 1+)7*7+%'E+ %&+%+0*#)%' #0([&*1' +0-$.+%'&*' '&+.q*G`G
-
7/24/2019 aria Alvarez
14/58
B$8-:9#4.$74Q' 5- -+H' &*#EY' >$74-'8-= 5- $7?-#59 $ 095-+9= ,$+45$59= (&;BB =79#-u DF >89= V$+79v :#?>9 G
;4 '9 @-'- 98#9= 2$789#-= 5- #4-=:9 >8"/XC 8>W3:8BC?6C e/@3?C
"=W? >+)#H' 80-$.+%'&*'6'4749 >#-79. 5- 8#$8$04-'89 &d [^ F C#= 5-+ 4':#-=9\ H$ =-$ 9#$+ 9 6i 79'09'489#4.$74Q' >9# +9 0-'9= 5- G C#= $'8-= 5- 5-7454# 79'5?78$ 5-q'4@,$
V#$8$04-'89 &d -0>)#479 9#$+ ,$+45$59 T+?9#9X?4'9+9'$w&09g474+4'$m$7 7+$,?+$'479 T+?9#9X?4'9+9'$w7+4'5$0474'$ =4 C$H $+-#:4$ $ /IB
"C =.$'&'4$*)'.')+ E* 1'0#)Z_ \#- #E%+)7' 1') (&'\.+h*EG
= *>?, @,-A> 2/.CB C.1P
-
7/24/2019 aria Alvarez
15/58
rs$9 (+E+ #) (#7*+%&[+t
-
7/24/2019 aria Alvarez
16/58
>'7#.'E 7# 1+%#Y'&*Z+1*_) 7# &*#EY' `+.*7+7'E
#) (+1*#)%#E (#7*F%&*1'E
-
7/24/2019 aria Alvarez
17/58
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, andthen open the file again. If the red x still appears, you may have to delete the image and then insert it again.The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then
open the file again. If the red x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete theimage and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or theimage may have been corrupted. Restart your computer, and then open the file again. If the red x stillappears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or theimage may have been corrupted. Restart your computer, and then open the file again. If the red x stillappears, you may have to delete the image and then insert it again.
-
7/24/2019 aria Alvarez
18/58
>'7#.' 7# (*11*_) 7# &*#EY' 7# 6),#11*_)-+1%#&*+)+ *)`+E'&+ #) )*U'E 1') 1F)1#&
8.%' ?*#EY' W+H' &*#EY'
/#-=-'74$ 5- 59= 2$789#-= 5- #4-=:9
7?$+X?4-#$/#-=-'74$ 5- $+:?'9 5- +9= =4:?4-'8-=2$789#-= 7909 2$789# x'479N
$\ /BW u ]EM\ 98-'=4Q'7\ W-7$)5$ 5- R-?7-04$
5\
R-?7-04$ '9 +4'29M+L=@7$
&?=-'74$ 5- 2$789#-= 5- #4-=:9
/#-=-'74$ 5- $+:?'9 5- +9= =:8-= 2$789#-=7909 2$789# x'479
$\ ^ O 5)$= 5-=5- 5)$ q'$+ 5-x+@0$ X?40498-#$>4$
M\ W-7?-'89 >+$X?-8$= ^ _E%EEE
Santolaya ME et al. Clin Infect Dis 2002; 35:678-83
]6"f8 A^6:/
-
7/24/2019 aria Alvarez
19/58
p+.*7+1*_) (&'E(#1;`+ 7#. 0'7#.' 7# (*11*_) 7#&*#EY' 6W6 aMQT #(*E'7*'Eb
;-'=4M4+45$5 ]DP e=>-74q745$5 OSP
i// lDP i/I ]EP
Santolaya ME et al. Clin Infect Dis 2002; 35:678-83
f*+Y)_E;1' 7# W+H' ?*#EY'
#(*E'7*'E )#$%&'(#)*+ ,#-&*.
-
7/24/2019 aria Alvarez
20/58
e' +9= ->4=9549= 5- M$f9 #4-=:9` 54$:'9=@79 7-#@q7$59 5- 4'2-774Q' ,4#$+ H$?=-'74$ 5- 7#48-#49= 5- :#$,-5$5` =- f?=@q7$ =?=>-'5-# -+ 8#$8$04-'89$'@047#9M4$'9 [&66\
/. %&+%+0*#)%' +0-$.+%'&*' 7# .'E )*U'E 1') "= 7# -+H' &*#EY' #E $)+ +.%#&)+;`+m;. j 1'),'&%+-.# (+&+ #. (+1*#)%#d 4$# E# (&+1;1+&F E* .+ +.*7+7 *)E;%$1*')+.7# +%#)1*_) 7# #E%'E )*U'E #E +(&'(*+7+
a8 6b
f*+Y)_E;1' j %&+%+0*#)%' 7# .+ )#$%&'(#)*+ ,#-&*. #))*U'E 1') 1F)1#&G
B9'=-'=9 5- +$ ;974-5$5 R$@'9$0-#47$'$ 5- 6'2-789+9:)$ /-54L8#47$%
e:6]/ MPIP8$%'E (&*)1*(+.#E #$ =$F[F 7%+\+ ]AF+V,Z Q*"N+R6 ]?-+%#A 7%:$+L+ GA,?>>+ QGA>?Y?+R6
7,VN+> GA,?>>+ QS-"+#A%R6 (?L"$>+ *+,?Z+ QS)^)7)R6 _+N?+,,$ *+%>$FF$ QG%+F?>R6 T?A `aI$Z ` Q*A>AKN?+R6 `A"%#$FE"$\+F #$ *8?-+F QS> H+>Y+#A%R6 b?%Z+ #$ `$a, QT+,+KcR6 =AFd (+%-a #$> TA,: Q7%L$,M,+R6 (+%?A ($>L+% Qe"+:$K+>+R6 +"%+ '+%+,fA Qg$,$Z"$>+R6 *+%>+ @#?A Q*AF:+ ]?-+R6 (a,?-+ ]A#%VL"$Z
QT+%+L"+WR6 (+%-$>A H-AI?,+%A Q7%L$,M,+R
-
7/24/2019 aria Alvarez
21/58
A')1.$E*')#E &59>8$# ?' 095-+9 5- 7$8-:9#4.$74Q' 5- #4-=:9 `+.*7+7'-
4'79#>9#$#+9 -' -+ 0$'-f9 #?@'$#49 5-+ >$74-'8- %
ITdW 79'=45-#$# 0$'-f9 $0M?+$89#49 9 $+8$ >#-79. =4 -g4=8-4'2#$-=8#?78?#$ X?- $=-:?#- 7?45$59=$ 09'489#4.$74Q' H=-:?404-'89%
B9'=45-#$# 8#$8$04-'89 $'@M4Q@79 9#$+ =4 -+ '4K9 -= 7$>$.
5- 89+-#$# -=$ ,)$%
b$"h$> $: +>)7,, @,-A>)2/..62212C3450378K$# $: +>)T$#?+:%?- G>AA# *+,-$%)2//PBP405+W+ $: +>)=)*>?,?- @,-A>B2//;B221CP4;54)H"IIA%: -+%$ -+,-$%)2/.2B2/1..C35;3
[FB\
[ Dd\
[ Dd\
= *>?, @,-A> 2/.2B C/1;;2P5;;C4)
-
7/24/2019 aria Alvarez
22/58
C$%(+;#)% +)7 '&+. +);-*';1 0+)+Y#0#)% ', .'lV&*Eg,#-&*.# )#$%&'(#)*+ + #u#1;`# *) 1S*.7) + EjE%#0+;1
`*#l ', (&'E(#1;`# %&*+.E
(-8$A$'L+4=4=
FS $#p7?+9=
l WBV H l >#9=>-7@,9= '9W
/(*E'7*'E 7# "=W?
FEOl 0$'-f$59= -' 29#0$ $0M?+$89#4$ Ol_ 8#$8$59= 79' &d 9#$+-=
hMf-@,9=
e,$+?$# -q7$74$ 5-+ 8#$8$04-'89 $0M?+$89#49 ,-#=?= C9=>48$+4.$59=
B90>$#$# 8-#$>4$ 9#$+ ,-#=?= 6i -' 4:?$+ >9M+$74Q'
H"IIA%: *+%$ *+,-$% 2/.2B2/1..C35;3
>+)#H' +0-$.+%'&*' j 0+)#H' 1') +);-*_;1'E '&+.#E #) )*U'E 1')"=W? E') #,#1;`'E j E#Y$&'E
-
7/24/2019 aria Alvarez
23/58
>+)#H' 7# "=W?)$#`+E 0'7+.*7+7#E %#&+(9$;1+E
>'7+.*7+7#E< V#$8$04-'89= $M#-,4$59= V#$8$04-'89= =-7?-'74$+-=
6im9#$+
48$+4.$59m$0M?+$89#49
B&+%+0*#)%'E E#1$#)1*+.#E
eq7$74$ =404+$# $ 095$+45$5 C9=>48$+4.$59 (-f9# -,9+?74Q' >=479=974$+ (-'9#-= 79=89= >$#$ +9= >$74-'8-= H +9= =-#,4749= 5- ;$+?5
T$:%?>>? $: +>)T$#?+:%?- 9,D E?F . P@,-A> .) *>?, 9,D$-: E?F .
-
7/24/2019 aria Alvarez
24/58
rs$9 (+E+ 1') .+ 1+.*7+7 7# `*7+t
-
7/24/2019 aria Alvarez
25/58
A+.*7+7 7# `*7+/h(.'&+ #E%&+%#Y*+ 7# 0+)#H' 7# "=
! V#$8$04-'89 C9=>48$+4.$59 79' &d6i
! V#$8$04-'89 9#$+ -' 7$=$ >9=8-#49#$ 4'4749 8#$8$04-'89 ei -' C9=>48$+
! V#$8$04-'89 $0M?+$89#49 790>+-896i
!
V#$8$04-'89 790>+-89 9#$+
87$.%'E
;?>>9#8 B$#- B$'7-# DEFDyDENDO__ASG
" Kvw (\#) %&+%+0*#)%'+ 0 - $ . + % ' & * ' d 1 ' ) Y & + )`+&*+-*.*7+7 *)7*`*7$+. 7#
(,#)1*+E
"*U'E
G% = *+,-$%)2/..B./3Q3R10/050..
>#H'& #`+.$+1*_)" ^'E(*%+.*Z+1*') 1') +.%+ ('Z
" 80-$.+%'&*' 1') %&+%+0*#)%' 6p
-
7/24/2019 aria Alvarez
26/58
r j .'E 1'E%'Et
-
7/24/2019 aria Alvarez
27/58
T$#?+:%?-F 2/..B.2PB$2P=4=%
-
7/24/2019 aria Alvarez
29/58
NeutropeniaFebril
Bajo Riesgo30%
AltoRiesgo70%
Sin Sepsis75%
Sepsis25%
Fallece No Fallece
(9#8$+45$5 :+9M$+ D%_P(9#8$+45$5 IT&W SP(9#8$+45$5 =->=4= F_P
H+,:A>+W+ (S $: +>)= *>?, @,-A> 2//;B221CP4;54
= *>?, 9,D$-: E?F 2//2BC310P454C
T$# 9,D$-: E?F) 2//P
-
7/24/2019 aria Alvarez
30/58
81%$+.0#)%#
e=2?-#.9= -=8L' 54#4:459= $ M?=7$# 095-+9= 5- >#-54774Q' 5-#4-=:9 5- =->=4= -' '4K9= 79' 7L'7-#` '-?8#9>-'4$
e'2#-'8$# -=89= ->4=9549= >#-79.0-'8- H -' 29#0$ 0L=$:#-=4,$
6':#-=9 4'0-54$89 $ 3B6/
3@+4.$74Q' 5- -=X?-0$= &( X?- 7?M#$' $:-'8-= W` >$#$
>9=8-#49#0-'8- 5- A -=7$+$#
H
-
7/24/2019 aria Alvarez
31/58
/$:$'4'4 9,D$-: 2/..B 24 QH"I> .R1 ./5C4
-
7/24/2019 aria Alvarez
32/58
/),)%+0*#)%' +1%$+. 7# .+ "= a6b
&>+47$# 095-+9= 5- >#-54774Q' 5- #4-=:9 5- 6d6
($'-f9 $0M?+$89#49 -' ITdW
67#);\1+& 6),#11*')#E W+1%#&*+)+E 6)`+E'&+E
8(.*1+& 0'7#.'E 7# (*11*_) 7# E#(E*E E#`#&+
f*+Y)_E;1' #;'._Y*1'
6)1'&('&+1*_) 7# )$#`+E S#&&+0*#)%+E 7*+Y)_E;1+E
W*'.'Y[+ 0'.#1$.+&
60>$789 5- +$= 4'2-7749'-= #-=>4#$89#4$= ,4#$+-= -' +$ -,9+?74Q' 5- -=89=>$74-'8-=
"4$:'Q=@79 047#9M49+Q:479 09+-7?+$# >$#$ $,$'.$# -' -+ 54$:'Q=@79 5-=->=4=%
-
7/24/2019 aria Alvarez
33/58
8)%#1#7#)%#E
! e+ 54$:'Q=@79 -@9+Q:479 -= 7#)@79 >$#$ -+ 8#$8$04-'89 9>9#8?'9 H$5-7?$59 5- +$ IT -' '4K9= 79' 7L'7-#%
! R9= C-097?+@,9= =9' >9=4@,9= -' FEAsEP 5- +9= ->4=9549=%
!"#$%&
Bacterias??
Hongos???
Bacterias
-
7/24/2019 aria Alvarez
34/58
-
7/24/2019 aria Alvarez
35/58
e#)E*-*.*7+7 j /E(#1*\1*7+7 7# .+E %91)*1+E $;.*Z+7+E
(+&+ 7#%#11*_) 7# `*&$E E(*&+%'&*'E
B91)*1+ e#)E*-*.*7+7 awb /E(#1*\1*7+7 awb
6'0?'9z?9#-=7-'74$ OE ]l
6T w B?+@,9 OD ]l
d49+9:)$ (9+-7?+$# ]G ]l
= *>?, (?-%AN?A> 2//
-
7/24/2019 aria Alvarez
36/58
f#%#11*_) 7# `*&$E E(*&+%'&*'E #) )*U'E 1') )#$%&'(#)*+ ,#-&*. a)nvPNb
-
7/24/2019 aria Alvarez
37/58
f*+Y)_E;1' #;'._Y*1'e>4=9549= 5- '-?8#9>-'4$ 2-M#4+
B'&E X] j 1'.EG 6fe8 MPIPd p+)1'$`#&d A+)+7F
-
7/24/2019 aria Alvarez
38/58
f#%#11*_) 7# `*&$E E(*&+%'&*'E #) )*U'E 1'))#$%&'(#)*+ ,#-&*.
-
7/24/2019 aria Alvarez
39/58
A'0(+&+1*_) #)% `*&$E E(*&+%'&*'E #)#(*E'7*'E 7# "= #) )*U'E
-
7/24/2019 aria Alvarez
40/58
]E#)%+1*_) j #`'.$1*_) 1.[)*1+
-
7/24/2019 aria Alvarez
41/58
A')1.$E*_)
R$= ,4#?= #-=>4#$89#49= =9' +9= >#4'74>$+-= $:-'8-= 5-8-78$59= -' -=8-:#?>9 5- >$74-'8-=` 8$'89 -' IT 5- $+89 H M$f9 #4-=:9 5- 6d6%
/$74-'8-= 79' 5-8-774Q' ,4#?= #-=>4#$89#49` =4' 5-8-774Q' 79',-'749'$+ 9
09+-7?+$# 5- 4'2-774Q' M$78-#4$'$ 8?,4-#9' -,9+?74Q' 2$,9#$M+-
R9= ->4=9549= 5- IT 7$?=$59= >9# 794'2-7749'-= #-=>4#$89#4$= ,4#$+-= H
794'2-7749'-= ,4#?= #-=>4#$89#49AM$78-#4$ '9 2?-#9' 0L= =-,-#$=%
A')'1#& ('Z0#)%# .+ #;'.'Y[+ 7# .+E "= +j$7+&[+ + '(;0*Z+& #.0+)#H' 7# #E%'E (+1*#)%#E j 7*E0*)$*& #. $E' 7# +);-*_;1'EG
I-?8#9>-'4$ T-M#4+
-
7/24/2019 aria Alvarez
42/58
>
&+89 W4-=:9 6d6d$f9 W4-=:9 6d6
i4#?=W-=> [w\d$78-#4$ [A\
&'@047#9M4$'9=
"mB &Vd&+8$
B9'8#9+&0M?+$A
89#49
B90>+-8$# &VdV#$8$04-'89
OAFE 5
i4#?= W-=> [w\d$78-#4$ [A\
i4#?= W-=> [w\d$78-#4$ [w\
i4#?= W-=> [A\d$78-#4$ [w\
i4#?= W-=> [A\d$78-#4$ [A\
"mB &VdhM=-#,$74Q'C9=>48$+4.$#
O5
&'@047#9M4$'9=
B9'@'?$# &Vde,$+?$74Q' B+)'47$ H R$M
")$ G
e,$+?$74Q' #4-=:9 =->=4= - 6d6 w -=8?549 047#9M49+9:479 w W/B ,4#$+ H M$78-#4$'$
T$,9#$M+-"-=2$,9#$M+-
B90>+-8$#&Vd
C9=>48$+4.$59
;9=>-7C$6'2-774Q' Tx':47$
B%'G ]'ZW&I` W&(` /BW`
B?+@,9=`
40L:-'-=` Z(`W/B 2x':47$
B%'G /0(*&*1'V#$8$04-'89$'@2x':479
f[+
O
&+-$89#4.$74Q'6)%#&`#)1*_) I
6)%#&`#)1*_) M
6)%#&`#)1*_) T
f[+
T
f[+I
B9'@'?$#&Vd
48$+4.$#O 5
&+-$89#4.$74Q'
f[+
v
i4#?=[w\d$78-#4$ [w\
i4#?=W-=> [A\d$78-#4$ [w\
i4#?= W-=> [A\d$78-#4$ [A\
B90>+-8$#&Vd
V#$8$04-'89OAFE 5
&+-$89#4.$74Q'
-
7/24/2019 aria Alvarez
43/58
B+-.+ MG a6)%#&`#)1*_) IbG "*U'E 1') #(*E'7*'E 7# )#$%&'(#)*+ ,#-&*. 7# -+H' &*#EY'1') *),#11*_) ('& $) `*&$E E(*&+%'&*' 7#0'E%&+7+d &+)7'0*Z+7'E + *-*& ' )'
%&+%+0*#)%' +);0*1&'-*+)' + (+&;& 7#. 7[+ T 7# #`'.$1*_)
A+&+1%#&[E;1+E
B*(' 7# 6)%#&`#)1*_)
;?=>-'=4Q'$'@047#9M4$'9=
($'8-'74Q'$'@047#9M4$'9=
[' { Fl\ [' { FE \
")$= 5- C9=>48$+4.$74Q'` 0-54$'$ [>D_ A O_\ _ S
")$= 5- q-M#-` 0-54$'$ [>D_ A O_\
D
s
")$= 5- $'@047#9M4$'9=` 0-54$'$ [>D_ A O_\ s O
e,9+?74Q' 2$,9#$M+-` ' [P\ Fl [FEE\ FE [FEE\
6'2-774Q' M$78-#4$'$ 4',$=9#$
"-09=8#$5$
E
E
/#9M$M+-
E
E
/9=4M+-
E
E
W-4'=8$+$74Q' 5- $'@047#9M4$'9` ' [P\
E
E
W-4':#-=9 C9=>48$+$#49` ' [P\
E
E
-
7/24/2019 aria Alvarez
44/58
B+-.+ TG a6)%#&`#)1*_) MbG "*U'E 1') #(*E'7*'E 7# )#$%&'(#)*+ ,#-&*. 7# +.%' &*#EY'1') *),#11*_) ('& $) `*&$E E(*&+%'&*' 7#0'E%&+7+d &+)7'0*Z+7'E + *-*& ' )'
%&+%+0*#)%' +);0*1&'-*+)' + (+&;& 7#. 7[+ T 7# #`'.$1*_)
A+&+1%#&[E;1+E
B*(' 7# 6)%#&`#)1*_)
;?=>-'=4Q' &Vd
B9' &Vd
[' { GE \
[' {DO \
")$= 5- C9=>48$+4.$74Q'` 0-54$'$ [>D_ A O_\
S
S`_
")$= 5- q-M#-` 0-54$'$ [>D_ A O_\
D
D
")$= 5- $'@047#9M4$'9=` 0-54$'$ [ >D_ A O_\
s
O
e,9+?74Q' 2$,9#$M+- [' yP\ sO []s\ DS []S\
6'2-774Q' M$78-#4$'$ 4',$=9#$
"-09=8#$5$
E
F [G\
/#9M$M+-
D [_\
E
/9=4M+-
E
E
W-4'=8$+$74Q' 5- $'@047#9M4$'9=` ' [P\
s [l\
"-=$##9++9 5- =->=4=` ' [P\
E
F [G\
6':#-=9 $ 3B6% I [P\
E
F [G\
T$++-7-` ' [P\
E
E
-
7/24/2019 aria Alvarez
45/58
/),)%+0*#)%' +1%$+. 7# .+ "= a66b
/.#11*_) 8> #0([&*1' *)*1*+.
B9'97404-'89 5- +$ e>45-049+9:)$ +97$+
&>+47$# 7$8-:9#4.$74Q' 5- #4-=:9
($'-f9 4'2-7749'-= 2x':47$=e0>)#479 ,-#=?= >#-A-0>@,-
h8#$= 8-#$>4$=
-
7/24/2019 aria Alvarez
46/58
A+0-*' #) .+ #(*7#0*'.'Y*+7# .+E "= #) .+E m.;0+E M 791+7+E
A+$E+E9# -+ ?=9 5- >#9q+$g4= $'@047#9M4$'$
($H9# ?=9 5- BiB
($H9# ?=9 5- >#97-5404-'89= 4',$=4,9=
48$+4.$749'-= >#9+9':$5$=
*+F:+L,A>+ S $: +>)SiI$%: @I?, SK$%L?,L E%"LF)2/.CB.4120C52P4
J"L8$F j b $: +>) *>?, 9,D$-: E?F 2//2B C;1 PC/53.
]+KI8+> ]) *>?, 9,D$-: E?F 2//;B C
-
7/24/2019 aria Alvarez
47/58
/`'.$1*_) 7# .+ /(*7#0*'.'Y[+
"Y7$5$ 5- +9= lE >#-5904'49 5- d$74+9= Z#$0 [A\ S)*A>?
!>$NF?$>>+ I,$"KA,?+$
TF$"#AKA,+ +$%"L?,AF+
"Y7$5$= >9=8-#49#-=`$?0-'89 5- 797$7-$= Z#$0 [w\
H:+I8W>A-A--"F -A+L">+F+ Q5R H:+I8W>A-A--"F +"%$"F
H:%$I:A-A--"F L%"IA Y?%?#+,F
&78?$+0-'8- -' &R 8-'5-'74$ $N
$?0-'89 5- Z#$0 [w\
6'2-7749'-= >9+4047#9M4$'$= &?0-'89 4'2-7749'-= >9# $:-'8-= W` X?- =- $=974$' $ u 09#8$+45$5
(+%-8$k @6 +,-$: 2//2B C3+W+ $: +>)]$Y *8?> 9,D$-: 2//3B 221 HP 2/.2B
-
7/24/2019 aria Alvarez
48/58
/(*7#0*'.'Y[+ #(*E'7*'E "=
Solis Y;Alvarez AM
Rev Chil Infect 2012
. [ -
-
7/24/2019 aria Alvarez
49/58
/;'.'Y[+ -+1%#&*+)+/(*E'7*'E "=
]6"f8 MPIMVMPIO
"=nTJM #(*E'7*'EB?+@,9=[w\ -' 0?-=8#$= 4',$=9#$={ OF [Fl%DP\IT&W{]SP
@&+0aVbnOOGJw @&+0axb n vPGNw
8Y#)%#E 0FE ,$#)%#EN
S)*A>? D]%_PH:+l>A-A--"F *A+LQ5R FO PH:+l>A-A--"F +"%$"F FO P!>$NF?$>>+ FI FG P
H:%$I:A-A--"F Y?%?#+,F FD%SPS,:$%A-A-A G%DPTF$"#AKA,+ FI F%G P98#9= l%_P
-
7/24/2019 aria Alvarez
50/58
]$Y *8?> 9,D$-: 2/..B 24 QH"I> .R1 ./5C4
B&+%+0*#)%' +);0*1&'-*+)' #0([&*1' *)*1*+.7#. )*U' 1') )#$%&'(#)*+ j \#-G
|e+ 8#$8$04-'89 5-M-#L -+-:4#=- -' M$=- $ +$= 7$#$78-#)=@7$= ->45-049+Q:47$= 5-+ +?:$#% ||;- #-7904-'5$ $:#-:$# ,$'790474'$ $ +9= >$74-'8-=79'N =9=>-7C$ 7+)'47$ 5- 4'2-774Q' $=974$5$ $ BiB` 4'2-774Q' 5- >4-+ H 8-f459= M+$'59= -' L#-$= 59'5- -g4=8$ ?'$ 8$=$ 5- H) +"%$"F %$F?F:$,:$ +K$M-?>?,+ #$ >+ -AK",?#+# m +> .3n6 ?,D$--?a, AF:$A +%M-">+%6 4'2-774Q' -' +9= 8#-= x+@09= 0-=-= >9# H) I,$"KA,?+$ %$F?F:$,:$ +$D+>AFIA%?,+F #$ Co L$,$%+-?a,6 $Y?#$,-?+ #$ F$IF?F W N+-:$%?$K?+ IA% -A-c-$+F L%+KIAF?MY+F6 I%$Y?A + +$ 45-'@q7$74Q' q'$+ H -,$+?$74Q' 5-=?=7->@M4+45$5% |||h>8$@,9%
-
7/24/2019 aria Alvarez
51/58
/),)%+0*#)%' +1%$+. 7# .+ "= a66b
/.#11*_) 8> #0([&*1' *)*1*+.
B9'97404-'89 5- +$ e>45-049+9:)$ +97$+
&>+47$# 7$8-:9#4.$74Q' 5- #4-=:9
>+)#H' *),#11*')#E ,m)Y*1+Ee0>)#479 ,-#=?= >#-A-0>@,-
h8#$= 8-#$>4$=
-
7/24/2019 aria Alvarez
52/58
B&+%+0*#)%' +);,m)Y*1'/$74-'8- 79' IT >-#=4=8-'8-
/0([&*1'
-
7/24/2019 aria Alvarez
53/58
B+-.+ OG a6)%#&`#)1*_) TbG "*U'E 1') #(*E'7*'E 7# )#$%&'(#)*+ ,#-&*. 7# +.%' &*#EY'1') 0+)%#)1*_) 7# \#- j )#$%&'(#)*+ +. 7[+ O 7# #`'.$1*_)d &+)7'0*Z+7'E +
*-*& %#&+(*+ +);,m)Y*1+ ( #0(;`# `#&E$E #0([&*1+
A+&+1%#&[E;1+E
B*(' 7# 6)%#&`#)1*_)
/#- A -0>@,-
e0>)#479
[' { FS \
[' { D_ \
")$= 5- C9=>48$+4.$74Q'` 0-54$'$ [>D_AO_\
DD
DF
")$= 5- q-M#-` 0-54$'$ [>D_ A O_\
FG
FE
")$= 5- $'@2x':479=` 0-54$'$ [>D_ A O_\
s
FDe,9+?74Q' 2$,9#$M+- [' yP\
FG [ll\
DD [ll\
6'2-774Q' 2x':47$ 4',$=9#$
"-09=8#$5$
D [Fs\
D [l\
/#9M$M+-
F [S\
s [FD\
/9=4M+-
E
s [FD\
W-X?4-#- 4'4749 $'@2x':479` ' [P\
l [_E\
E
W-X?4-#- 0954q7$74Q' $'@2x':479` ' [P\
G [D_\
S [DG\
6':#-=9 $ 3B6` ' [P\
s [F]\
S [DG\
T$++-7-` ' [P\
D [Fs\
s [FD\
-
7/24/2019 aria Alvarez
54/58
"=< '%&+E %#&+(*+E
B-.61/)5 )5CDE&-$6)5 *) .1&1$=-5
7+I%A (H)$: +> S"% f *+,-$% 2/..B;P145C2
HK?:8b= $: +> = *>?, @,-A> 2//0B2;1C.4P52/3
G$%L8K+,F b $: +>)H"IIA:% *+%$ 2//2B./1.4.54
(?:-8$>> T` $: +>)= *>?, @,-A> .
-
7/24/2019 aria Alvarez
55/58
=+.%+ 1+0*)' ('& '&&
"-M-09= -=@0?+$# $ +9= 542-#-'8-= :#?>9= 5- 8#$M$f9 #-:49'$+-=` $0$'-f$# $ +9= >$74-'8-= 5- ?'$ 0$'-#$ ?'429#0- H 0L= #$749'$+ %
-
7/24/2019 aria Alvarez
56/58
j+ 4$#yG
V-'-09= -' R$@'9 &0Y#47$` M$=-= 74-'pq7$= =Q+45$= `79' 0'7#.'E 7#(*11*_) 7# &*#EY'` `+.*7+7'E` %+)%' (+&+ 6W6 1'0' 7# E#(E*E j0'&%+.*7+7d 1') -$#) )*`#. 7# #`*7#)1*+` >$#$ ?@+4.$# -' -+ 0$'-f9 5-'?-=8#9= >$74-'8-=
e+ 0$'-f9 $0M?+$89#49 -' +9= >$74-'8-= 79' ITdW` #E ('E*-.#d E#Y$&' j#\1+Zd 79' 542-#-'8-= 095$+45$5-= H 79' 542-#-'8-= -=X?-0$=$'@047#9M4$'9=
e' ITdW` -+ 54$:'Q=@79 7-#@q7$59 5- 4'2-774Q' ,4#$+ H $?=-'74$ 5-
7#48-#49= 5- :#$,-5$5` >-#04@#L =?=>-'5-# -+ 8#$8$04-'89 $'@047#9M4$'9
eg4=8-' >?M+47$749'-= X?- 0?-=8#$' +$ e>45-049+9:)$ +97$+
-
7/24/2019 aria Alvarez
57/58
e*) #0-+&Y'~%
"-M-09= -=29#.$#'9= -' -+ $E' &+1*')+. 7# 8> >$#$ -,48$# $?0-'89 5-
7->$= W` ?@+4.$'59 +$ ->45-049+9:)$ +97$+
"-M-09= 4'79#>9#$# $ 4)%#)E*`*E%+E -' -+ 0$'-f9 >#-79. 5- '4K9= 79'2$789#-= 5- #4-=:9 5- =->=4= H 0?-#8-
3@+4.$# 895$= +$= C-##$04-'8$= 54=>9'4M+-= >$#$ ++-:$# $ ?' 7*+Y)_E;1'
#;'._Y*1' '9 =9+9 ,4#$+ 9 M$78-#4$'9` =4'9 8$0M4Y' 5- 4'2-7749'-= 2x':47$=
-
7/24/2019 aria Alvarez
58/58
@&+1*+E
"#$% &'$ ($#)$ &+,$#-. /$+0$
1-2$ 3'45$5 5- 6'2-789+9:4$
;-#,4749 5- /-54$8#4$
48$+ ;$' 1?$' 5- "49=
;$'@$:9ABC4+-
top related