Las infecciones de transmisión sexual es una de las causas mas frecuentes de consulta médica. A nivel mundial se ha visto un aumento en el número de casos, por lo que se hace necesario realizar guías y consensos para la prevención y el tratamiento de estas enfermedades. En el siguiente trabajo, se realiza el conceso sobre prevención de infecciones de transmisión que abarca desde la prevención primaria, la realización de la consulta médica, los tipos de pruebas y el manejo ante una potencial exposición. Se ha desarrollado una adaptación de guías internacionales y nacionales, de manera que sean de fácil aplicabilidad en nuestro territorio nacional, y que faciliten la consulta para los médicos en cualquier nivel de atención.
Syphilis is a sexually transmitted disease caused by Treponema pallidum subsp. pallidum, with a high incidence in patients living with HIV. HIV-syphilis coinfection may present with atypical cutaneous manifestations of secondary syphilis, including pustular, papulosquamous, photodistributed, nodular ulcerative (malignant syphilis), fungal-like, plaque-like, overlapping stages, and nodular forms. We report a case of a man with HIV diagnosed with secondary syphilis presenting with infiltrated erythematous-violaceous plaques. The differential diagnoses included leprosy, erythema nodosum, and cutaneous mastocytosis. Serology and skin biopsy confirmed the diagnosis. The patient received three weekly doses of benzathine penicillin, achieving complete resolution of the lesions after the first administration. At three months, serology showed a fourfold decline in rapid plasma reagin titers, confirming the therapeutic response. Subsequently, after antiretroviral therapy, the patient achieved viral suppression and immunological recovery. This case highlights the importance of recognizing the varied cutaneous manifestations of secondary syphilis in patients with HIV to guide timely diagnosis and adequate management.
Antibiotic combination therapy is widely used in clinical practice; however, its application often lacks a clear understanding of the underlying pharmacological principles. This review critically examines the rationale, benefits, and limitations of combination therapy by integrating evidence from in vitro studies, animal models, and the relevant clinical literature. Elicit was used as a support tool to assist in the organization and analysis of the selected studies. While combinations may broaden antimicrobial coverage, enhance bactericidal activity, or prevent resistance, they can also result in additive or antagonistic interactions that limit their clinical effectiveness. This review emphasizes that antibiotic combinations should not be guided by empirical intuition but approached as a rational strategy supported by well-defined therapeutic goals and strong scientific evidence to optimize clinical outcomes and address antimicrobial resistance with greater precision.
Fecal microbiota transplantation (FMT) is an increasingly indicated therapy for intestinal disorders. This meta-meta-analysis aimed to evaluate the clinical outcomes of FMT in ulcerative colitis, Crohn’s disease, and recurrent CDI. We searched the PubMed online database for meta-analyses of intestinal disorders. After accounting for overlap, 11 publications on CDI and 13 on inflammatory intestinal diseases were obtained. Based on a meta-meta-analysis of these patients, this study quantified the impact of FMT on clinical outcomes. We combined the effects under the random-effects model and pooled the estimates as odds ratios (OR). In recurrent CDI, clinical remission was identified in 86% of patients in the FMT group versus 49% (n=449) in the control group [OR 1.82, CI95% 1.69-1.96, P < 0.0001]. Eleven studies included data from patients with ulcerative colitis in clinical remission, identified in 36% (n=903) of patients in the FMT group versus 16% (n=217) in the control group [OR 3.58, CI95% 2.99-4.28, P < 0.0001]. FMT in patients with Crohn’s disease was not different from that in the controls. FMT is a promising therapy for recurrent CDI and ulcerative colitis; however, more clinical trials are needed, as well as standardization of the FMT technique and preparation.
Introduction: Latent tuberculosis infection (LTBI) is characterized by a sustained immune response to Mycobacterium tuberculosis antigens without clinical, radiographic, or microbiological evidence of active disease. The aim of this study was to assess medical and social risk factors for progression of latent tuberculosis infection (LTBI) to active pulmonary tuberculosis in children with household TB contact. Materials and methods: A prospective study (2022-2024) involved 120 children aged 4-12 with LTBI. Two groups were formed: children who developed active TB (LTBI-to-TB group) and those who remained latent. Inclusion required consent. Clinical, immunological (IL-2, IgM), and social factors were analyzed. Risk was evaluated via relative risk (RR) and 95% confidence intervals. Results: Progression to active TB was linked to bacillary TB contact (RR=6.5), maternal TB (RR=5.2), anemia (RR=3.8), >= 5 ARI episodes/year (RR=26.0), ineffective BCG (RR=3.0), single-parent homes (RR=11.0), territorial TB (RR=4.5), helminthiasis (RR=10.0), chickenpox (RR=5.0), genitourinarydiseases (RR=8.0), ENT pathology (RR=5.7), isoniazid monotherapy (RR=2.7), COVID-19 or HIV exposure (RR=8.0), IL-2 >= 311.1 ng/ml, and IgM >= 1.18 IU/ml. Discussions: Immunological and social factors increase LTBI progression risk. High-risk children need tailored monitoring.
