The advent of SARS-CoV-2 disease in 2020 confronts us with a growing and exponential increase in patients at life risk due to catastrophic and multisystemic respiratory failure in need of extracorporeal membrane oxygenation (ECMO) to survive. This has generated in our country the establishment of ECMO treatment Units in hospitals where it was not carried out before or was carried out as part the interventions in Intensive Care Units (ICU), becoming a new challenge to the infection control and prevention programs. Given that at the time of writing this document there are no specific national regulations that refer to this issue, an approach is proposed for the prevention control and surveillance of nosocomial acquired infections in ECMO patients. A review of the specific risks to which these patients are exposed is presented, defining which prevention measures are required, proposing a specific bundle for installation and maintenance, as well as guidance regarding antibioprophylaxis and suggesting which infectious events to monitor.

La aparicion de la enfermedad por SARS-CoV-2 el ano 2020 nos enfrento a un aumento creciente y exponencial de pacientes con riesgo vital por falla respiratoria catastrofica y multisistemica que deben ser sometidos a ECMO para sobrevivir. Esto ha generado en nuestro pais la aparicion de Unidades de Tratamiento ECMO en hospitales en que antes no se disponia de este recurso o se realizaba como parte de las intervenciones en Unidades de Cuidados Intensivos (UCI), lo que constituye un nuevo desafio a los programas de control y prevencion de infecciones de los centros de salud. Dado que al momento de la redaccion de este documento no existe normativa nacional especifica que se refiera a este tema, se propone un enfoque para prevencion, control y vigilancia de infecciones asociadas a atencion de salud en pacientes ECMO. Se presenta una revision de los riesgos especificos a que estan expuestos estos pacientes, definiendo que medidas de prevencion se requieren, proponiendo un conjunto de medidas especificas para instalacion y mantencion, asi como orientacion respecto de antibioprofilaxis y se sugiere que eventos infecciosos vigilar.

UNLABELLED:During year 2011 two outbreaks of Salmonella infection captured media attention in the Metropolitan Area (MA) in Chile: one of typhoid fever associated to Salmonella serotype Typhi, and the other, of gastroenteritis related to Salmonella serotype Enteritidis, both with decreasing or stable rates in the previous years. The aim of this work is to analyze probable causes of their reemergence.METHODS:Several government websites were searched looking for epidemiological data.RESULTS:Typhoid fever rates have declined to current values of 1 case per 100.000 habitants, a decreased associated to improvements in the human development index. The typhoid outbreak was associated to a predominant clone within the MA. The only risk factor identified was consumption of raw vegetables acquired in open fairs, but without identifying a common source. Despite improvements in disease notification and molecular epidemiology capabilities, this outbreak is coincidental with a reduced number of food inspection visits in the MA, probably explained by the limited personnel available for this task. In the case of Salmonella Enteritidis, rates have increased twice since 1998 (5.3 to 10.7 per 100.000 habitants) with an important increase in the number of outbreaks linked to this agent (7 to 31 annual outbreaks) since year 2005. Persistence of this problem is probably associated to the low surveillance of poultry farms made by the Chilean state, to the absence of a cold chain during collection, distribution and selling of eggs, and to the lack of an educational program directed to the population. The recent regulation that bans home-made mayonnaise in restaurant or fast food stores is an important advance that requires further evaluation.CONCLUSIONS:The persistence and reemergence of different kind of Salmonellosis in Chile suggests chronic problems on the size and role of the Chilean state regarding food safety.

Mites that affect animals (acariasis) can occasionally be transmitted to humans by incidental contact producing pruritus and dermatitis. Animals such as dogs, cats, mice, birds and reptiles, harbour several mite species. Hemophage mites and those that feed on lymph have the potential of transmitting important zoonotic agents (cuales??). The presence of lesions of unclear origin and a history of contact with pets or wild animals should alert towards the possibility of acariasis. Diagnosis is based on direct visualization of the mite,analysis of its morphology and obtaining information on the animal host. Awareness of these acarosis and the responsible care of pets and animals are the most relevant preventive measures.

Mites that affect animals (acariasis) can occasionally be transmitted to humans by incidental contact producing pruritus and dermatitis. Animals such as dogs, cats, mice, birds and reptiles, harbour several mite species. Hemophage mites and those that feed on lymph have the potential of transmitting important zoonotic agents (cuales??). The presence of lesions of unclear origin and a history of contact with pets or wild animals should alert towards the possibility of acariasis. Diagnosis is based on direct visualization of the mite,analysis of its morphology and obtaining information on the animal host. Awareness of these acarosis and the responsible care of pets and animals are the most relevant preventive measures.

Part V. Laboratory diagnosis of Chagas diseaseIn this fifth part of Guidelines for Chagas disease, diagnostic techniques for Trypanosoma cruzi infection in humans are reviewed, the interpretation of laboratory results and an algorithm for laboratory diagnosis in immunocompetent hosts are presented.Chagas disease may be diagnosed by three kinds of techniques: direct, which allow detect the presence of the parasite in different kind of samples; indirect, based on the search of immune specific response against T. cruzi antigens and molecular, which detect parasite genetic material.Direct techniques are utilized mainly in acute phase of disease, as the parasite is present in blood of infected host.These techniques do not require be confirmed by other methods.For chronic undetermined phase and for symptomatic phase it is recommended to use indirect techniques; generally, immunoassay techniques (ELISA) that detect IgG antibodies directed against T. cruzi antigens are performed.As false positive results are possible, a positive or undetermined result must be confirmed by at least another technique (indirect immunofluorescence or indirect hemmaglutination).In Chile, confirmation of infection is performed by the Instituto de Salud Pública National Reference Laboratory or at surrogate centers.Molecular methods may be used to make the diagnosis in acute or chronic phase of infection, with more accuracy in the acute phase, and it is mainly recommended to diagnose vertical transmission of T. cruzi as early diagnosis of congenital infection increases the possibility to cure the sibling and besides it is a good marker to evaluate the effectiveness of treatment.

In this fifth part of Guidelines for Chagas disease, diagnostic techniques for Trypanosoma cruzi infection in humans are reviewed, the interpretation of laboratory results and an algorithm for laboratory diagnosis in immunocompetent hosts are presented. Chagas disease may be diagnosed by three kinds of techniques: direct, which allow detect the presence of the parasite in different kind of samples; indirect, based on the search of immune specific response against T. cruzi antigens and molecular, which detect parasite genetic material. Direct techniques are utilized mainly in acute phase of disease, as the parasite is present in blood of infected host. These techniques do not require be confirmed by other methods. For chronic undetermined phase and for symptomatic phase it is recommended to use indirect techniques; generally, immunoassay techniques (ELISA) that detect IgG antibodies directed against T. cruzi antigens are performed. As false positive results are possible, a positive or undetermined result must be confirmed by at least another technique (indirect immunofluorescence or indirect hemmaglutination). In Chile, confirmation of infection is performed by the Instituto de Salud Pública National Reference Laboratory or at surrogate centers. Molecular methods may be used to make the diagnosis in acute or chronic phase of infection, with more accuracy in the acute phase, and it is mainly recommended to diagnose vertical transmission of T. cruzi as early diagnosis of congenital infection increases the possibility to cure the sibling and besides it is a good marker to evaluate the effectiveness of treatment.

As expert consensus has been arisen about universal antiparasitic treatment for all patients infected with Trypanosoma cruzi, most important drugs licensed for Chagas disease treatment are reviewed: nifurtimox and benznidazol, their mechanisms of action, doses, treatment schedules, adverse effects and contraindications. Two other drugs used for Chagas disease treatment, for which a Chilean experience may be exhibited, are allopurinol and itraconazole. Indications for treatment of Chagas disease in immunocompetent patients and immunocompromised hosts are detailed. This chapter refers besides to the evaluation and monitoring of antiparasitic therapy in immunocompromised patients, the availability of drugs and includes various forms facsimiles suggested to perform clinical and laboratory follow up of patients that undergo treatment, indicating the prescribed drug, adverse effects and time of follow up.

Part II. Chagas disease in adults, infancy and adolescenceThe different stages of Chagas disease in adults: acute, undetermined or latent and chronic phases are described.This document contains guidelines for etiological diagnosis of Chagas disease and its treatment.In chronic phase, as cardiac and digestive system (esophagus and colon) are affected, symptoms and signs, evolution of the disease, laboratory analysis and treatment are described.The following topics in congenital Chagas disease are boarded: its prevalence in pregnant women, the importance of mother phase of disease, repercussions of the parasite transmission to the fetus, the frequency of transmission, how the infection to the fetus is produced, the importance of chronic infection in consecutive pregnancies, and clinical consequences to the newborn infant including symptoms of congenital disease.Concomitance with human immunodeficiency virus is commented.No vertically transmitted Chagas disease in infancy and adolescents has similar clinical manifestations as in adults.Direct and indirect laboratory tests of infection are described and an algorithm for diagnosis and follow up of vertical transmission of Trypanosoma cruzi is presented.