Marcelo Del Castillo | Pontificia Universidad Católica Argentina (original) (raw)
Papers by Marcelo Del Castillo
Medicina, 2022
Background: Information about COVID infection in physicians is limited. This knowledge would allo... more Background: Information about COVID infection in physicians is limited. This knowledge would allow the implementation of actions to reduce its impact. The objective was determining the incidence of SARSCoV-2 infection in physicians from health institutions in Argentina, its characteristics, and associated factors. Methods: We conducted a multicenter prospective / retrospective cohort study with nested case-control study. Physicians active at the beginning of the pandemic were included, those on leave due to risk factors were excluded. The incidence of confirmed cases was estimated. We conducted bivariate analyses with various factors and used those significant in a logistic regression. Results: Three hundred and forty three physicians with COVID-infection from 8 centers were included. The incidence of disease was 12.1% and that of global absenteeism related to COVID, 34.1%. Almost 70% of close contacts were work-related. In the multivariate analysis living in Autonomous City of Buenos Aires (CABA) (OR 0.19, p = 0.01), working in high-risk areas (OR 0.22, p = 0.01) and individual transportation (OR 0, 34, p = 0.03) reduced the risk of COVID. The odds of infection increased 5.6 times (p = 0.02) for each close contact isolation. Discussion: The number of close contact isolation increased considerably the risk of infection. Living in Buenos Aires City, individual transportation and working in high-risk areas reduced it. Given the high frequency of close contact in the workplace, we strongly recommend the reinforcement of prevention measures in rest areas and non-COVID-wards.
International Journal of Infectious Diseases, 2018
New Microbes and New Infections, 2017
New Microbes and New Infections, 2016
Journal of Hospital Infection, 2010
Journal of Clinical Microbiology, 2013
Here, we describe the first case of a Streptococcus lutetiensis isolate harboring the lnuB gene.
International Journal of Infectious Diseases, 2010
Journal of Antimicrobial Chemotherapy, 2017
Background: Substantial heterogeneity in the epidemiology and management of Staphylococcus aureus... more Background: Substantial heterogeneity in the epidemiology and management of Staphylococcus aureus bacteraemia (SAB) occurs in Latin America. We conducted a prospective cohort study in 24 hospitals from nine Latin American countries. Objectives: To assess the clinical impact of SAB in Latin America. Patients and methods: We evaluated differences in the 30 day attributable mortality among patients with SAB due to MRSA compared with MSSA involving 84 days of follow-up. Adjusted relative risks were calculated using a generalized linear model. Results: A total of 1030 patients were included. MRSA accounted for 44.7% of cases with a heterogeneous geographical distribution. MRSA infection was associated with higher 30 day attributable mortality [25% (78 of 312) versus 13.2% (48 of 363), adjusted RR: 1.94, 95% CI: 1.38-2.73, P , 0.001] compared with MSSA in the multivariable analysis based on investigators' assessment, but not in a per-protocol analysis [13% (35 of 270) versus 8.1% (28 of 347), adjusted RR: 1.10, 95% CI: 0.75-1.60, P " 0.616] or in a sensitivity analysis using 30 day allcause mortality [36% (132 of 367) versus 27.8% (123 of 442), adjusted RR: 1.09, 95% CI: 0.96-1.23, P " 0.179]. MRSA infection was not associated with increased length of hospital stay. Only 49% of MSSA bloodstream infections (BSI) received treatment with b-lactams, but appropriate definitive treatment was not associated with lower mortality (adjusted RR: 0.93, 95% CI: 0.70-1.23, P " 0.602). Conclusions: MRSA-BSIs in Latin America are not associated with higher 30 day mortality or longer length of stay compared with MSSA. Management of MSSA-BSIs was not optimal, but appropriate definitive therapy did not appear to influence mortality.
Prensa médica argentina, 2002
The optimal management of infectious wastes and prevention and control of nosocomial infections, ... more The optimal management of infectious wastes and prevention and control of nosocomial infections, with special reference to guidelines for hospital environmental control, are described in this article.
Infections associated with neurosurgical procedures are serious complications that contribute to ... more Infections associated with neurosurgical procedures are serious complications that contribute to the morbidity and mortality of neurocritical patients, as well as to the prolongation of the stay in the ICU and the hospital. The diagnosis is complex since there is no gold standard, so it is based on clinical suspicion, CSF physical-chemical examination, and microbial isolation. Treatment should be initiated early, guided by local epidemiology. The duration will depend on the causative microorganism, its sensitivity and the availability of antibiotic treatments that are effective at the site of infection. The implementation of preventive measures with proven efficacy minimizes the risk of infection. This SADI-SATI intersociety update reviews relevant data recently published on this area at the national at international level regarding epidemiology, diagnostic methodologies, therapeutic approaches, and prevention guidelines.
The Lancet Global Health, 2019
![Research paper thumbnail of [Mycoplasma pneumoniae meningoencephalitis in a young adult]](https://attachments.academia-assets.com/88088987/thumbnails/1.jpg)
](Medicina, 2005
Mycoplasma pneumoniae infections have extrapulmonary complications that involve the nervous syste... more Mycoplasma pneumoniae infections have extrapulmonary complications that involve the nervous system. The neurologic manifestations are diverse. Although the prognosis is usually favorable, the patients can undergo severe permanent sequelae. We present a young female adult with acute meningoencephalitis as a complication of a lower respiratory infection, which followed a benign course without neurologic sequelae.
MEDICINA (Buenos …, 2004
Las infecciones por Candida son responsables de muchas infecciones hospitalarias, siendo la cuart... more Las infecciones por Candida son responsables de muchas infecciones hospitalarias, siendo la cuarta causa de bacteriemia nosocomial 1, 2 . Son frecuentes en las unidades de cuidados intensivos (UCI) en pacientes sometidos a numerosas maniobras invasivas y múltiples ...
Revista de Neurología, 2019
![Research paper thumbnail of [Treatment with caspofungin of Candida tropicalis endocarditis resistant to fluconazol]](https://attachments.academia-assets.com/77943025/thumbnails/1.jpg)
](Medicina, 2004
Fungal endocarditis, in particular due to Candida species, requires medical and surgical treatmen... more Fungal endocarditis, in particular due to Candida species, requires medical and surgical treatment and amphotericin B is the drug of choice. Caspofungin is an echinocandin very effective against Candida and Aspergillus. We present a patient with Candida tropicalis endocarditis, fluconazol resistant, treated with caspofungin, on a compassional basis as a result of adverse effects with amphotericin B. The patient had a microbiological response.
Neurology, 2017
Objective: To evaluate the clinical presentation of both patients with herpetic encephalitis (HE)... more Objective: To evaluate the clinical presentation of both patients with herpetic encephalitis (HE) and those with Neurological Conditions which are Not typically associated with HSV (NCNH), and to propose physiopathological explanations to the presence of HSV in CSF in both situations. Background: Herpes Simplex Viruses (HSV) have been commonly associated with diverse neurological conditions. However, some NCNH can also present with a positive PCR in CSF, whose significance is uncertain. Design/Methods: 1590 HSV PCR studies were reviewed. A retrospective analysis evaluating clinical presentation, workup (MRI, EEG and CSF-analysis) and outcome of 73 patients with HSV positive PCR in CSF was conducted during the period Jan 2007–Sep 2015 in our institution. Patients U18 and those with non-encephalitic HSV conditions were excluded. A group comparison between HE and NCNH patients was conducted using parametric/non parametric tests accordingly. Results: Sixteen patients with HE and 23 with...
Medicina-buenos Aires, 2005
Palabras clave: meningoencefalitis, Mycoplasma pneumoniae Abstract Mycoplasma pneumoniae meningoe... more Palabras clave: meningoencefalitis, Mycoplasma pneumoniae Abstract Mycoplasma pneumoniae meningoencephalitis in a young adult. Mycoplasma pneumoniae infections have extrapulmonary complications that involve the nervous system. The neurologic manifestations are diverse. Although the prognosis is usually favorable, the patients can undergo severe permanent sequelae. We present a young female adult with acute meningoencephalitis as a complication of a lower respiratory infection, which followed a benign course without neurologic sequelae.
The Neurologist
Herpes simplex viruses (HSV) can produce encephalitis (HSE), which requires early detection, typi... more Herpes simplex viruses (HSV) can produce encephalitis (HSE), which requires early detection, typically using polymerase chain reaction (PCR) in cerebrospinal fluid (CSF). However, other neurological conditions not directly caused by HSV may also present with a positive HSV PCR in the CSF (NCNHPCR+). We aimed to analyze the clinical features of both groups of patients (HSE vs. NCNHPCR+) and to consider the potential relevance of this finding in the latter. A retrospective analysis of clinical presentation, workup (CSF, EEG, and MRI) and outcome of patients with an HSV+ result in CSF was conducted from Jan-2007 to Sep-2015 in our institution. Patients under 18 years and those with nonencephalitic HSV associated disorders were excluded. Group comparison between HSE and NCNHPCR+ patients was conducted using parametric and nonparametric tests accordingly. Sixteen HSE and 23 NCNHPCR+ patients were included. Patients with HSE presented a higher incidence of headache (87.5% vs. 43.5%; P=0.008), meningeal symptoms (50% vs. 17.4%; P=0.04), pleocytosis (75% vs. 18%; P=0.001), EEG abnormalities (46.67% vs. 22%; P=0.02) and typical MRI findings (50% vs. 0%; P<0.001), whereas 35% of patients with NCNHPCR+ had an underlying immunologic disorder (35% vs. 0%; P=0.012). The pathogenic role of HSV in NCNHPCR+ is uncertain. This finding must be interpreted in the appropriate clinical, EEG, and neuroimaging context. Immunocompromise and neuroinflammation states could be related to a higher presence of HSV in CSF.
Medicina, 2017
Early recognition and prompt specific treatment are crucial factors influencing the outcome of pa... more Early recognition and prompt specific treatment are crucial factors influencing the outcome of patients with acute encephalitis. The aim of this study was to determine the main causes of acute encephalitis in our population and to find predictors that may lead to specific diagnosis. Adult patients admitted to our hospital with suspected diagnosis of encephalitis in the period 2006-2013 were included. One hundred and five medical records were analyzed. Eighty-two patients with infectious encephalitis were identified (78% of total cases), 53 (65%) men and 29 (35%) women, mean age 47.8 years. The most common microorganisms identified were: HSV-1 (11%), VZV (10%), HSV-2 (5%) and EBV (5%). Twenty-three patients (22% of the series) had non-infectious encephalitis. Headache (p < 0.0001) and fever (p = 0.008) were more frequent in encephalitis of infectious origin. Protein levels and white blood cell counts in the cerebrospinal fluid were significantly higher in patients affected by infe...
Medicina, 2022
Background: Information about COVID infection in physicians is limited. This knowledge would allo... more Background: Information about COVID infection in physicians is limited. This knowledge would allow the implementation of actions to reduce its impact. The objective was determining the incidence of SARSCoV-2 infection in physicians from health institutions in Argentina, its characteristics, and associated factors. Methods: We conducted a multicenter prospective / retrospective cohort study with nested case-control study. Physicians active at the beginning of the pandemic were included, those on leave due to risk factors were excluded. The incidence of confirmed cases was estimated. We conducted bivariate analyses with various factors and used those significant in a logistic regression. Results: Three hundred and forty three physicians with COVID-infection from 8 centers were included. The incidence of disease was 12.1% and that of global absenteeism related to COVID, 34.1%. Almost 70% of close contacts were work-related. In the multivariate analysis living in Autonomous City of Buenos Aires (CABA) (OR 0.19, p = 0.01), working in high-risk areas (OR 0.22, p = 0.01) and individual transportation (OR 0, 34, p = 0.03) reduced the risk of COVID. The odds of infection increased 5.6 times (p = 0.02) for each close contact isolation. Discussion: The number of close contact isolation increased considerably the risk of infection. Living in Buenos Aires City, individual transportation and working in high-risk areas reduced it. Given the high frequency of close contact in the workplace, we strongly recommend the reinforcement of prevention measures in rest areas and non-COVID-wards.
International Journal of Infectious Diseases, 2018
New Microbes and New Infections, 2017
New Microbes and New Infections, 2016
Journal of Hospital Infection, 2010
Journal of Clinical Microbiology, 2013
Here, we describe the first case of a Streptococcus lutetiensis isolate harboring the lnuB gene.
International Journal of Infectious Diseases, 2010
Journal of Antimicrobial Chemotherapy, 2017
Background: Substantial heterogeneity in the epidemiology and management of Staphylococcus aureus... more Background: Substantial heterogeneity in the epidemiology and management of Staphylococcus aureus bacteraemia (SAB) occurs in Latin America. We conducted a prospective cohort study in 24 hospitals from nine Latin American countries. Objectives: To assess the clinical impact of SAB in Latin America. Patients and methods: We evaluated differences in the 30 day attributable mortality among patients with SAB due to MRSA compared with MSSA involving 84 days of follow-up. Adjusted relative risks were calculated using a generalized linear model. Results: A total of 1030 patients were included. MRSA accounted for 44.7% of cases with a heterogeneous geographical distribution. MRSA infection was associated with higher 30 day attributable mortality [25% (78 of 312) versus 13.2% (48 of 363), adjusted RR: 1.94, 95% CI: 1.38-2.73, P , 0.001] compared with MSSA in the multivariable analysis based on investigators' assessment, but not in a per-protocol analysis [13% (35 of 270) versus 8.1% (28 of 347), adjusted RR: 1.10, 95% CI: 0.75-1.60, P " 0.616] or in a sensitivity analysis using 30 day allcause mortality [36% (132 of 367) versus 27.8% (123 of 442), adjusted RR: 1.09, 95% CI: 0.96-1.23, P " 0.179]. MRSA infection was not associated with increased length of hospital stay. Only 49% of MSSA bloodstream infections (BSI) received treatment with b-lactams, but appropriate definitive treatment was not associated with lower mortality (adjusted RR: 0.93, 95% CI: 0.70-1.23, P " 0.602). Conclusions: MRSA-BSIs in Latin America are not associated with higher 30 day mortality or longer length of stay compared with MSSA. Management of MSSA-BSIs was not optimal, but appropriate definitive therapy did not appear to influence mortality.
Prensa médica argentina, 2002
The optimal management of infectious wastes and prevention and control of nosocomial infections, ... more The optimal management of infectious wastes and prevention and control of nosocomial infections, with special reference to guidelines for hospital environmental control, are described in this article.
Infections associated with neurosurgical procedures are serious complications that contribute to ... more Infections associated with neurosurgical procedures are serious complications that contribute to the morbidity and mortality of neurocritical patients, as well as to the prolongation of the stay in the ICU and the hospital. The diagnosis is complex since there is no gold standard, so it is based on clinical suspicion, CSF physical-chemical examination, and microbial isolation. Treatment should be initiated early, guided by local epidemiology. The duration will depend on the causative microorganism, its sensitivity and the availability of antibiotic treatments that are effective at the site of infection. The implementation of preventive measures with proven efficacy minimizes the risk of infection. This SADI-SATI intersociety update reviews relevant data recently published on this area at the national at international level regarding epidemiology, diagnostic methodologies, therapeutic approaches, and prevention guidelines.
The Lancet Global Health, 2019
Medicina, 2005
Mycoplasma pneumoniae infections have extrapulmonary complications that involve the nervous syste... more Mycoplasma pneumoniae infections have extrapulmonary complications that involve the nervous system. The neurologic manifestations are diverse. Although the prognosis is usually favorable, the patients can undergo severe permanent sequelae. We present a young female adult with acute meningoencephalitis as a complication of a lower respiratory infection, which followed a benign course without neurologic sequelae.
MEDICINA (Buenos …, 2004
Las infecciones por Candida son responsables de muchas infecciones hospitalarias, siendo la cuart... more Las infecciones por Candida son responsables de muchas infecciones hospitalarias, siendo la cuarta causa de bacteriemia nosocomial 1, 2 . Son frecuentes en las unidades de cuidados intensivos (UCI) en pacientes sometidos a numerosas maniobras invasivas y múltiples ...
Revista de Neurología, 2019
Medicina, 2004
Fungal endocarditis, in particular due to Candida species, requires medical and surgical treatmen... more Fungal endocarditis, in particular due to Candida species, requires medical and surgical treatment and amphotericin B is the drug of choice. Caspofungin is an echinocandin very effective against Candida and Aspergillus. We present a patient with Candida tropicalis endocarditis, fluconazol resistant, treated with caspofungin, on a compassional basis as a result of adverse effects with amphotericin B. The patient had a microbiological response.
Neurology, 2017
Objective: To evaluate the clinical presentation of both patients with herpetic encephalitis (HE)... more Objective: To evaluate the clinical presentation of both patients with herpetic encephalitis (HE) and those with Neurological Conditions which are Not typically associated with HSV (NCNH), and to propose physiopathological explanations to the presence of HSV in CSF in both situations. Background: Herpes Simplex Viruses (HSV) have been commonly associated with diverse neurological conditions. However, some NCNH can also present with a positive PCR in CSF, whose significance is uncertain. Design/Methods: 1590 HSV PCR studies were reviewed. A retrospective analysis evaluating clinical presentation, workup (MRI, EEG and CSF-analysis) and outcome of 73 patients with HSV positive PCR in CSF was conducted during the period Jan 2007–Sep 2015 in our institution. Patients U18 and those with non-encephalitic HSV conditions were excluded. A group comparison between HE and NCNH patients was conducted using parametric/non parametric tests accordingly. Results: Sixteen patients with HE and 23 with...
Medicina-buenos Aires, 2005
Palabras clave: meningoencefalitis, Mycoplasma pneumoniae Abstract Mycoplasma pneumoniae meningoe... more Palabras clave: meningoencefalitis, Mycoplasma pneumoniae Abstract Mycoplasma pneumoniae meningoencephalitis in a young adult. Mycoplasma pneumoniae infections have extrapulmonary complications that involve the nervous system. The neurologic manifestations are diverse. Although the prognosis is usually favorable, the patients can undergo severe permanent sequelae. We present a young female adult with acute meningoencephalitis as a complication of a lower respiratory infection, which followed a benign course without neurologic sequelae.
The Neurologist
Herpes simplex viruses (HSV) can produce encephalitis (HSE), which requires early detection, typi... more Herpes simplex viruses (HSV) can produce encephalitis (HSE), which requires early detection, typically using polymerase chain reaction (PCR) in cerebrospinal fluid (CSF). However, other neurological conditions not directly caused by HSV may also present with a positive HSV PCR in the CSF (NCNHPCR+). We aimed to analyze the clinical features of both groups of patients (HSE vs. NCNHPCR+) and to consider the potential relevance of this finding in the latter. A retrospective analysis of clinical presentation, workup (CSF, EEG, and MRI) and outcome of patients with an HSV+ result in CSF was conducted from Jan-2007 to Sep-2015 in our institution. Patients under 18 years and those with nonencephalitic HSV associated disorders were excluded. Group comparison between HSE and NCNHPCR+ patients was conducted using parametric and nonparametric tests accordingly. Sixteen HSE and 23 NCNHPCR+ patients were included. Patients with HSE presented a higher incidence of headache (87.5% vs. 43.5%; P=0.008), meningeal symptoms (50% vs. 17.4%; P=0.04), pleocytosis (75% vs. 18%; P=0.001), EEG abnormalities (46.67% vs. 22%; P=0.02) and typical MRI findings (50% vs. 0%; P<0.001), whereas 35% of patients with NCNHPCR+ had an underlying immunologic disorder (35% vs. 0%; P=0.012). The pathogenic role of HSV in NCNHPCR+ is uncertain. This finding must be interpreted in the appropriate clinical, EEG, and neuroimaging context. Immunocompromise and neuroinflammation states could be related to a higher presence of HSV in CSF.
Medicina, 2017
Early recognition and prompt specific treatment are crucial factors influencing the outcome of pa... more Early recognition and prompt specific treatment are crucial factors influencing the outcome of patients with acute encephalitis. The aim of this study was to determine the main causes of acute encephalitis in our population and to find predictors that may lead to specific diagnosis. Adult patients admitted to our hospital with suspected diagnosis of encephalitis in the period 2006-2013 were included. One hundred and five medical records were analyzed. Eighty-two patients with infectious encephalitis were identified (78% of total cases), 53 (65%) men and 29 (35%) women, mean age 47.8 years. The most common microorganisms identified were: HSV-1 (11%), VZV (10%), HSV-2 (5%) and EBV (5%). Twenty-three patients (22% of the series) had non-infectious encephalitis. Headache (p < 0.0001) and fever (p = 0.008) were more frequent in encephalitis of infectious origin. Protein levels and white blood cell counts in the cerebrospinal fluid were significantly higher in patients affected by infe...