Caracterización demográfica, clínica y hallazgos del líquido cefalorraquídeo en infecciones del Sistema Nervioso Central de pacientes con inmunosupresión asociada a tumores sólidos y neoplasias hematolinfoides en el Instituto Nacional de Cancerología en el periodo de 2010 – 2020. Un estudio descriptivo y retrospectivo

Texto con Figuras y Tablas múltiples

Autores:
Ariza Varon, Michael Andres
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Fecha de publicación:
2022
Institución:
Universidad Nacional de Colombia
Repositorio:
Universidad Nacional de Colombia
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spa
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https://repositorio.unal.edu.co/handle/unal/80854
https://repositorio.unal.edu.co/
Palabra clave:
610 - Medicina y salud::616 - Enfermedades
Infecciones del Sistema Nervioso Central
Meningoencefalitis
Neoplasias
Neurocirugía
Trasplantes
Protocolos de quimioterapia combinada
Radioterapia
Central Nervous System Infections
Meningoencephalitis
Neoplasms
Neurosurgery
Transplants
Combined chemoteraphy protocols
Radiotherapy
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id UNACIONAL2_b4c91fca21228cbf16ffe17562ca168c
oai_identifier_str oai:repositorio.unal.edu.co:unal/80854
network_acronym_str UNACIONAL2
network_name_str Universidad Nacional de Colombia
repository_id_str
dc.title.spa.fl_str_mv Caracterización demográfica, clínica y hallazgos del líquido cefalorraquídeo en infecciones del Sistema Nervioso Central de pacientes con inmunosupresión asociada a tumores sólidos y neoplasias hematolinfoides en el Instituto Nacional de Cancerología en el periodo de 2010 – 2020. Un estudio descriptivo y retrospectivo
dc.title.translated.eng.fl_str_mv Demographic, clinical characterization and cerebrospinal fluid findings in Central Nervous System infections in patients with immunosuppression associated with solid tumors and hematolymphoid neoplasms at the National Cancer Institute in the period 2010-2020. A descriptive and retrospective study
title Caracterización demográfica, clínica y hallazgos del líquido cefalorraquídeo en infecciones del Sistema Nervioso Central de pacientes con inmunosupresión asociada a tumores sólidos y neoplasias hematolinfoides en el Instituto Nacional de Cancerología en el periodo de 2010 – 2020. Un estudio descriptivo y retrospectivo
spellingShingle Caracterización demográfica, clínica y hallazgos del líquido cefalorraquídeo en infecciones del Sistema Nervioso Central de pacientes con inmunosupresión asociada a tumores sólidos y neoplasias hematolinfoides en el Instituto Nacional de Cancerología en el periodo de 2010 – 2020. Un estudio descriptivo y retrospectivo
610 - Medicina y salud::616 - Enfermedades
Infecciones del Sistema Nervioso Central
Meningoencefalitis
Neoplasias
Neurocirugía
Trasplantes
Protocolos de quimioterapia combinada
Radioterapia
Central Nervous System Infections
Meningoencephalitis
Neoplasms
Neurosurgery
Transplants
Combined chemoteraphy protocols
Radiotherapy
title_short Caracterización demográfica, clínica y hallazgos del líquido cefalorraquídeo en infecciones del Sistema Nervioso Central de pacientes con inmunosupresión asociada a tumores sólidos y neoplasias hematolinfoides en el Instituto Nacional de Cancerología en el periodo de 2010 – 2020. Un estudio descriptivo y retrospectivo
title_full Caracterización demográfica, clínica y hallazgos del líquido cefalorraquídeo en infecciones del Sistema Nervioso Central de pacientes con inmunosupresión asociada a tumores sólidos y neoplasias hematolinfoides en el Instituto Nacional de Cancerología en el periodo de 2010 – 2020. Un estudio descriptivo y retrospectivo
title_fullStr Caracterización demográfica, clínica y hallazgos del líquido cefalorraquídeo en infecciones del Sistema Nervioso Central de pacientes con inmunosupresión asociada a tumores sólidos y neoplasias hematolinfoides en el Instituto Nacional de Cancerología en el periodo de 2010 – 2020. Un estudio descriptivo y retrospectivo
title_full_unstemmed Caracterización demográfica, clínica y hallazgos del líquido cefalorraquídeo en infecciones del Sistema Nervioso Central de pacientes con inmunosupresión asociada a tumores sólidos y neoplasias hematolinfoides en el Instituto Nacional de Cancerología en el periodo de 2010 – 2020. Un estudio descriptivo y retrospectivo
title_sort Caracterización demográfica, clínica y hallazgos del líquido cefalorraquídeo en infecciones del Sistema Nervioso Central de pacientes con inmunosupresión asociada a tumores sólidos y neoplasias hematolinfoides en el Instituto Nacional de Cancerología en el periodo de 2010 – 2020. Un estudio descriptivo y retrospectivo
dc.creator.fl_str_mv Ariza Varon, Michael Andres
dc.contributor.advisor.none.fl_str_mv Cuervo Maldonado, Sonia Isabel
Saavedra Estupiñan, Miriam
dc.contributor.author.none.fl_str_mv Ariza Varon, Michael Andres
dc.contributor.researchgroup.spa.fl_str_mv Greicah Grupo en Enfermedades Infecciosas en Cáncer y Alteraciones Hematológicas
Grupo de Investigación en Neurología de la Universidad Nacional de Colombia - Neuronal
dc.subject.ddc.spa.fl_str_mv 610 - Medicina y salud::616 - Enfermedades
topic 610 - Medicina y salud::616 - Enfermedades
Infecciones del Sistema Nervioso Central
Meningoencefalitis
Neoplasias
Neurocirugía
Trasplantes
Protocolos de quimioterapia combinada
Radioterapia
Central Nervous System Infections
Meningoencephalitis
Neoplasms
Neurosurgery
Transplants
Combined chemoteraphy protocols
Radiotherapy
dc.subject.proposal.spa.fl_str_mv Infecciones del Sistema Nervioso Central
Meningoencefalitis
Neoplasias
Neurocirugía
Trasplantes
Protocolos de quimioterapia combinada
Radioterapia
dc.subject.proposal.eng.fl_str_mv Central Nervous System Infections
Meningoencephalitis
Neoplasms
Neurosurgery
Transplants
Combined chemoteraphy protocols
Radiotherapy
description Texto con Figuras y Tablas múltiples
publishDate 2022
dc.date.accessioned.none.fl_str_mv 2022-02-02T14:08:58Z
dc.date.available.none.fl_str_mv 2022-02-02T14:08:58Z
dc.date.issued.none.fl_str_mv 2022-01-26
dc.type.spa.fl_str_mv Trabajo de grado - Especialidad Médica
dc.type.driver.spa.fl_str_mv info:eu-repo/semantics/masterThesis
dc.type.version.spa.fl_str_mv info:eu-repo/semantics/acceptedVersion
dc.type.content.spa.fl_str_mv Text
dc.type.redcol.spa.fl_str_mv http://purl.org/redcol/resource_type/TM
status_str acceptedVersion
dc.identifier.uri.none.fl_str_mv https://repositorio.unal.edu.co/handle/unal/80854
dc.identifier.instname.spa.fl_str_mv Universidad Nacional de Colombia
dc.identifier.reponame.spa.fl_str_mv Repositorio Institucional Universidad Nacional de Colombia
dc.identifier.repourl.spa.fl_str_mv https://repositorio.unal.edu.co/
url https://repositorio.unal.edu.co/handle/unal/80854
https://repositorio.unal.edu.co/
identifier_str_mv Universidad Nacional de Colombia
Repositorio Institucional Universidad Nacional de Colombia
dc.language.iso.spa.fl_str_mv spa
language spa
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dc.publisher.place.spa.fl_str_mv Bogotá, Colombia
dc.publisher.branch.spa.fl_str_mv Universidad Nacional de Colombia - Sede Bogotá
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spelling Atribución-NoComercial 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Cuervo Maldonado, Sonia Isabel8b45c15b8c35afce253a5861965c00f8Saavedra Estupiñan, Miriamed4cc7e2ed86aa8d027c036a79a62f88Ariza Varon, Michael Andres69a38c10f96682b1addcf4fea4548c74Greicah Grupo en Enfermedades Infecciosas en Cáncer y Alteraciones HematológicasGrupo de Investigación en Neurología de la Universidad Nacional de Colombia - Neuronal2022-02-02T14:08:58Z2022-02-02T14:08:58Z2022-01-26https://repositorio.unal.edu.co/handle/unal/80854Universidad Nacional de ColombiaRepositorio Institucional Universidad Nacional de Colombiahttps://repositorio.unal.edu.co/Texto con Figuras y Tablas múltiplesilustraciones, gráficos, tablasIntroducción: Las infecciones del Sistema Nervioso Central en pacientes oncológicos no han sido evaluadas en Latinoamérica, sin embargo, revisten una gran importancia dada su morbimortalidad. Objetivos: Describir las características demográficas, clínicas y microbiológicas de los pacientes con diagnóstico de cáncer hematolinfoide o de órgano sólido con infección del sistema nervioso central. Pacientes: Se eligieron pacientes en todos los rangos de edad con diagnóstico confirmado de cáncer sólido o hematolinfoide, con líquido cefalorraquídeo positivo para algún microorganismo. Se excluyeron pacientes en quienes los datos no fueran suficientes o confiables. Diseño: Estudio descriptivo, transversal y retrospectivo de los últimos 11 años en el Instituto Nacional de Cancerología-ESE (2010-2020). Se tomaron los resultados positivos del líquido cefalorraquídeo para buscar las variables de interés, se recolectaron los datos en la base RedCap por dos revisores independientes. El análisis de la información se hizo en STATA 16 para posteriormente generar las medidas estadísticas correspondientes. Resultados: 85 pacientes, edad media de 37 años, predominio masculino, procedencia más frecuente Cundinamarca. Presentaban neoplasia de órgano sólido (70,6%) o hematolinfoide (29,4%) con predominancia de tumores intracraneales. 50% de pacientes tuvieron manejo neuroquirúrgico, 56% quimioterapia y 34,1% radioterapia. El síndrome clínico más frecuente fue la meningitis (57,6%). El 81,2% tuvieron diagnóstico por cultivo, Staphylococcus y entero bacterias fueron los gérmenes más frecuentes. Se detectaron también infecciones virales, micóticas y parasitarias. El 98,8% de los pacientes fue tratado con agentes específicos o empíricos y la mortalidad ocurrió en 41,2% de los pacientes. Conclusiones: Este es el primer estudio en Latinoamérica que evalúa neuroinfecciones y pacientes oncológicos, además el segundo en incluir solo infecciones con germen confirmado y análisis por subgrupos. El tipo de neoplasia y los gérmenes causales difieren de lo reportado en la literatura. Obtuvimos una mayor mortalidad y un porcentaje de secuelas mayor a lo evaluado en estudios previos. (Texto tomado de la fuente)Introduction: Central Nervous System infections in cancer patients have not been evaluated in Latin America, however they are of great importance given their morbidity and mortality. Objectives: To describe the demographic, clinical and microbiological characteristics of patients diagnosed with hematolymphoid or solid organ cancer with central nervous system infection. Patients: Patients in all age ranges with a confirmed diagnosis of solid or hematolymphoid cancer, with positive cerebrospinal fluid for a microorganism, were chosen. Patients in whom the data were not sufficient or reliable were excluded. Design: Descriptive, cross-sectional and retrospective study of the last 11 years at the National Cancer Institute-ESE (2010-2020). The positive results of the cerebrospinal fluid were taken to look for the variables of interest, the data were collected in the RedCap database by two independent reviewers. The information analysis was done in STATA 16 to later generate the corresponding statistical measures. Results: 85 patients, mean age 37 years, male predominance, most frequent origin Cundinamarca. They presented solid organ neoplasia (70.6%) or hematolymphoid (29.4%) with a predominance of intracranial tumors. 50% of patients had neurosurgical management, 56% chemotherapy and 34.1% radiotherapy. The most frequent clinical syndrome was meningitis (57.6%). 81.2% had a diagnosis by culture, Staphylococcus and entero bacteria were the most frequent germs. Viral, fungal and parasitic infections were also detected. 98.8% of the patients were treated with specific or empirical agents and mortality occurred in 41.2% of the patients. Conclusions: This is the first study in Latin America to evaluate neuroinfections and cancer patients, as well as the second to include only infections with a confirmed germ and subgroups analysis. The type of neoplasm and the causative germs differ from that reported in the literature. We obtained a higher mortality and a higher percentage of sequelae than that evaluated in previous studies.Especialidades MédicasEspecialista en Neurología ClínicaEste es un estudio descriptivo, transversal y retrospectivo de los últimos once años (2010-2020) en el Instituto Nacional de Cancerología (INC-ESE), tomando como población todos los pacientes con un diagnóstico de tumor sólido o neoplasia hematolinfoide confirmada, con o sin tratamiento oncoespecífico, quirúrgico o no quirúrgicos, atendidos en la institución, quienes contaban con líquido cefalorraquídeo positivo y un microorganismo identificado por cualquier método diagnóstico confirmatorio incluyendo cultivo, coloración de Gram, antígenos, Film array o hemocultivos para infecciones bacterianas agudas; tinta china, antígenos por látex, ensayo de flujo lateral o cultivo para infecciones micóticas; PCR (Reacción en Cadena de la Polimerasa) para virus; VDRL para Treponema pallidum y resultados de Ziehl-Neelsen, cultivo o PCR para Mycobacterium tuberculosis (disponible recientemente); También se consideró incluir pacientes con LCR anormal e identificación imagenológica de una infección exclusivamente si esta no puede ser demostrada en LCR como toxoplasmosis y LMP (No se cuenta con los métodos específicos en LCR). A partir de esta identificación, realizada desde el laboratorio, se buscaron en las historias clínicas de los pacientes seleccionados y se describieron las variables de interés demográfico, clínico oncológico, clínico neuroinfectológico, hallazgos de LCR, agente microbiológico identificado, tratamiento empírico o específico y los desenlaces de los pacientes. Se realizó un análisis estadístico univariado mediante el cálculo de medidas de tendencia central y de dispersión para las variables cuantitativas y se presentarán frecuencias absolutas y relativas para variables categóricas. Se implementarán análisis bivariados utilizando las pruebas de Ji cuadrado y Fisher para las variables categóricas y las pruebas T o de Wilcoxon en el caso de variables continuas de acuerdo con la distribución de probabilidad de los datos. El nivel de confianza para todos los cálculos será de 95%. Objetivos Objetivo Principal Identificar las características demográficas, clínicas y de laboratorio de los pacientes oncológicos de cualquier edad con confirmación de una infección del sistema nervioso central mediante líquido cefalorraquídeo positivo con identificación para un microorganismo determinado entre 2010 y 2020. Objetivos específicos ▪ Describir las variables sociodemográficas de los pacientes con diagnóstico de infección del sistema nervioso central atendidos en el INC entre 2010 y 2020. ▪ Describir los tumores sólidos y las neoplasias hematolinfoides más frecuentes de los pacientes con infecciones del sistema nervioso central atendidos en el INC-ESE entre 2010 y 2020. ▪ Identificar el agente etiológico, las manifestaciones clínicas, los hallazgos del LCR y los hallazgos de la neuroimagen, tomografía y/o resonancia de los pacientes (si está disponible) de los pacientes con infección del sistema nervioso central teniendo en cuenta si hay o no antecedente quirúrgico. ▪ Describir cuáles son las infecciones del SNC en pacientes con diagnósticos de cáncer de órgano sólido y cuáles son las que presentan los pacientes con neoplasia hematolinfoides. ▪ Especificar los agentes etiológicos de las infecciones de SNC de los pacientes sometidos a tratamientos quimioterapéuticos convencionales, radioterapia e inmunoterapia. ▪ Definir la mortalidad a 30 días de los pacientes oncológicos diagnosticados con infecciones del sistema nervioso central en el grupo de estudio. Sujetos de estudio La población a estudio son pacientes de cualquier edad atendidos en el INC-ESE que hayan tenido cultivo de líquido cefalorraquídeo positivo (por punción lumbar u otros métodos de obtención) o un examen confirmatorio de neuroinfección para cualquier microorganismo entre los años 2010 - 2020 y que tengan diagnóstico confirmado de un tumor de órgano sólido o una neoplasia de células hematolinfoides. Criterios de inclusión: ▪ Pacientes atendidos en el Instituto Nacional de Cancerología de Colombia. ▪ Diagnóstico de tumor de órgano sólido o neoplasia de células hematolinfoides confirmado. ▪ Líquido cefalorraquídeo obtenido y procesado en la institución positivo para cualquier agente infeccioso, obtenido con o sin intervención neuroquirúrgica. ▪ Evidencia en LCR analizado compatible con infección del sistema nervioso central por método confirmatorio. ▪ Imagen sugestiva de una patología infecciosa del sistema nervioso central incluyendo abscesos o lesiones de la sustancia blanca y que no puedan ser confirmados por LCR. ▪ Necesidad de tratamiento antibiótico, antiviral o específico para el germen en cuestión. ▪ Seguimiento intrainstitucional de la patología infecciosa. Criterios de exclusión: ▪ Otro diagnóstico es más probable que una infección del SNC en el paciente. ▪ Líquido cefalorraquídeo no procesado en la institución. ▪ Historia clínica ausente o incompleta. Variables de estudio (Ver Anexo A: Formato de recolección) ▪ Demográficas: Edad, Sexo, Estado Civil, Escolaridad, Departamento de Procedencia, Municipio de Procedencia, Estrato socioeconómico. ▪ Clínicas Oncológicas: Diagnóstico oncológico, fecha del diagnóstico oncológico, tipo de neoplasia, estadio oncológico al diagnóstico, neoplasia intracraneal primaria, metástasis intracraneal, intervención Neuroquirúrgica, trasplante de órgano solido o trasplante de células hematopoyéticas, uso de quimioterapia, tipo de quimioterapia, fecha de ultima quimioterapia, uso de radioterapia, fecha de ultima radioterapia, uso de inmunosupresores, tipo de inmunosupresor. ▪ Clínicas Neurológicas: Síndrome Clínico (meningitis, meningoencefalitis, absceso o asintomático), síntomas de neuroinfección (cefalea, fiebre, alteración de la conciencia, convulsiones, focalización), signos de neuroinfección (Fotofobia, signos meníngeos, rigidez nucal). ▪ Paraclínicos: Fecha del diagnóstico de neuroinfección. Cultivo (Positivo o Negativo). Examen diagnóstico diferente al cultivo (coloración de Gram, antígenos, Film array o hemocultivos para infecciones bacterianas agudas; tinta china, antígenos, flujo lateral o cultivo para infecciones micóticas; PCR para virus; VDRL para Treponema pallidum y resultados de Ziehl-Neelsen, cultivo o PCR para Mycobacterium tuberculosis). Agente infeccioso, tipo de Neuroinfección, hallazgos de LCR incluyendo leucocitos, neutrófilos, linfocitos, proteínas, glucosa, relación glucosa sérica/glucosa en LCR, lactato, resonancia cerebral y tomografía cerebral. ▪ Tratamiento: Inicio de terapia específica para el agente infeccioso posible, determinado o probable. Nombre del tratamiento empírico o específico. Fecha de inicio del antimicrobiano. Fecha de finalización del antimicrobiano. Tiempo de administración total del antimicrobiano. ▪ Desenlaces: Fecha de ingreso, Fecha de egreso, seguimiento al día 30 (Vivo o muerto), mortalidad en el evento, complicaciones asociadas (hidrocefalia, absceso, ventriculitis, trombosis venosa), secuelas (físicas, cognitivas, lenguaje, epilepsia). Procedimientos Caracterización de los pacientes incluidos - Obtención de los reportes de LCR compatibles con infección del sistema nervioso central en los pacientes atendidos entre 2010 y 2020 en el INC-ESE. - Revisión de cada uno de los pacientes incluidos en la base de datos a quienes les fueron aplicados los criterios de inclusión y de exclusión, para identificar los pacientes que serían tenidos en cuenta en el protocolo. - Ingreso a las historias clínicas de cada uno de los pacientes seleccionados mediante el sistema SAP institucional para realizar la extracción de la información general de cada uno de ellos. Generación de una base de datos - Diligenciamiento de instrumento de captura generado en RedCap (variables sociodemográficas, clínicas, paraclínicas, tratamiento y desenlaces). - Generación de una base que recopile la información de los pacientes que fueron seleccionados. - Revisión y validación de la base de datos generada, con visto bueno de la oficina de monitoria y del Data Manager (Grupo Área Análisis de Datos). Análisis de la información Una vez la información fue recolectada, validada su calidad, y verificada contra la fuente, se generó una base de datos definitiva, sobre la cual se realizaron los análisis estadísticos correspondientes en el programa STAT 16 y se hizo el análisis cualitativo y cuantitativo de los datos para generar los resultados que se muestran en la sección subsecuente.Infecciones del sistema nervioso en cáncerxii, 90 páginasapplication/pdfspaUniversidad Nacional de ColombiaBogotá - Medicina - Especialidad en Neurología ClínicaDepartamento de Medicina InternaFacultad de MedicinaBogotá, ColombiaUniversidad Nacional de Colombia - Sede Bogotá610 - Medicina y salud::616 - EnfermedadesInfecciones del Sistema Nervioso CentralMeningoencefalitisNeoplasiasNeurocirugíaTrasplantesProtocolos de quimioterapia combinadaRadioterapiaCentral Nervous System InfectionsMeningoencephalitisNeoplasmsNeurosurgeryTransplantsCombined chemoteraphy protocolsRadiotherapyCaracterización demográfica, clínica y hallazgos del líquido cefalorraquídeo en infecciones del Sistema Nervioso Central de pacientes con inmunosupresión asociada a tumores sólidos y neoplasias hematolinfoides en el Instituto Nacional de Cancerología en el periodo de 2010 – 2020. 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Acta Otorrinolaringol Esp. 2012 May-Jun;63(3):241-3. Spanish. doi: 10.1016/j.otorri.2011.01.006. Epub 2011 Mar 22. PMID: 21429468.Neuro infección en el paciente oncológicoEstudiantesInvestigadoresMaestrosPúblico generalORIGINAL1024519037.2022.pdf1024519037.2022.pdfTesis de Especialización Médica en Neurología Clínicaapplication/pdf1679986https://repositorio.unal.edu.co/bitstream/unal/80854/3/1024519037.2022.pdf220f901f64a905ce11bbdfe12419d2ffMD53LICENSElicense.txtlicense.txttext/plain; charset=utf-84074https://repositorio.unal.edu.co/bitstream/unal/80854/4/license.txt8153f7789df02f0a4c9e079953658ab2MD54THUMBNAIL1024519037.2022.pdf.jpg1024519037.2022.pdf.jpgGenerated Thumbnailimage/jpeg5278https://repositorio.unal.edu.co/bitstream/unal/80854/5/1024519037.2022.pdf.jpgd45222ff0c036afd19538d3704426d61MD55unal/80854oai:repositorio.unal.edu.co:unal/808542024-08-02 23:10:48.499Repositorio Institucional Universidad Nacional de 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EVESURBIFBPUiBMQSBTRUNSRVRBUsONQSBHRU5FUkFMLiAqTEEgVEVTSVMgQSBQVUJMSUNBUiBERUJFIFNFUiBMQSBWRVJTScOTTiBGSU5BTCBBUFJPQkFEQS4gCgpBbCBoYWNlciBjbGljIGVuIGVsIHNpZ3VpZW50ZSBib3TDs24sIHVzdGVkIGluZGljYSBxdWUgZXN0w6EgZGUgYWN1ZXJkbyBjb24gZXN0b3MgdMOpcm1pbm9zLiBTaSB0aWVuZSBhbGd1bmEgZHVkYSBzb2JyZSBsYSBsaWNlbmNpYSwgcG9yIGZhdm9yLCBjb250YWN0ZSBjb24gZWwgYWRtaW5pc3RyYWRvciBkZWwgc2lzdGVtYS4KClVOSVZFUlNJREFEIE5BQ0lPTkFMIERFIENPTE9NQklBIC0gw5psdGltYSBtb2RpZmljYWNpw7NuIDE5LzEwLzIwMjEK

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