Etiología del síndrome febril agudo en la provincia de Jaén, Perú 2004-2005

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Abstract

Objetivo: Conocer a tiología el Síndrome febril agudo en nacientes que acudieron a tres establecimientos de salud de la provincia de Jaén entre mayo de 2004 y abril de 2005. Materiales y métodos: Estudio descriptivo prospectivo realizado en tres establecimientos de salud: Hospital General de Jaén, Hospital de Apoyo Bellavista y Centro de Salud Morro Solar. Se incluyeron pacientes entre 5 y 65 años con fiebre de menos de ocho días de evolución y sin foco infeccioso aparente. Inicialmente se les realizó gota gruesa para malaria y frotis sanguíneo para Bartonelosis; de los casos negativos se obtuvo una segunda muestra de sangre para la búsqueda de ELISA IgM y microaglutinación para el diagnóstico de leptospirosis, ELISA IgM para dengue, Mayaro, Oropuche y encefalitis equina venezolana, e inmunofluorescencia indirecta para Rickettsiosis. Resultados: De 1039 febriles incluidos, se determinó la etiología en 680 (65,4%)casos, malaria por P.falciparum 312 (30,0%), leptospirosis 115 (11,1%), dengue 105 (10,1%), malaria por P. vivax 76 (7,3%),leptospirosis más dengue 30 (2,9%), Rickettsiosis 15 (1,4%),Bartonelosis 17 (1,6%),leptospirosis más Rickettsiosis 7 (0,7%), y leptospirosis, dengue más Rickettsiosis 3 (0,3%). Los serovares de Leptospira más frecuentes fueron varilla (35,7%)y bratislava (32,5%). Conclusión: La malaria es la principal causa de síndrome febril agudo en Jaén, se destaca la presencia de la leptospirosis como segunda causa,por delante del dengue; es necesario considerar dentro del diagnóstico diferencial Rickettsiosis y Bartonelosis.

Translated abstract

Objective: To know the etiology of acute febrile syndrome in patients presenting to three healthcare facilities in Jaen province,between May 2004 and April 2005. Materials and methods: A prospective and descriptive study was performed in three healthcare facilities:Jaen General Hospital,Bellavista Support Hospital and Morro Solar Health Center.Patients between 5 and 65 years were included.They had fever for less than eight days and with no apparent infectious etiology. Initially patients were screened with a thick smear blood test for malaria and a thin smear for Bartonellosis.Patients reported as negative for these test underwent a second blood test which included the following assays:IgM ELISA and microagglutination for leptospirosis,IgM ELISA for dengue fever,Mayaro,Oropuche and Venezuelan equine encephalitis, and indirect immunofluorescence for Rickettsiosis. Results: Of 1039 febrile patients included,a diagnosis was made in 80 65,4%)ases:P.alciparum malaria in 12 30,0%),eptospirosis in 15 11,1%),engue ever n 05 10,1%), P.vivax malaria in 76 (7,3%),leptospirosis and dengue fever in 30 (2,9%),rickettsiosis in 15 (1,4%),and leptospirosis plus dengue plus Rickettsiosis in 3 (0,3%).Most frequent Leptospira serovars were varilla (35,7%)and bratislava (32,5%). Conclusion: Malaria is the main cause of acute febrile syndrome in Jaen.It is also noteworthy the presence of leptospirosis in second place,above dengue fever;it is necessary to include this condition,as well as Bartonellosis and Rickettsiosis in the differential diagnosis.

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Environmental and social influences on emerging infectious diseases: past, present and future.

Geoffrey A. McMichael (2004)

During the processes of human population dispersal around the world over the past 50 000-100 000 years, along with associated cultural evolution and inter-population contact and conflict, there have been several major transitions in the relationships of Homo sapiens with the natural world, animate and inanimate. Each of these transitions has resulted in the emergence of new or unfamiliar infectious diseases. The three great historical transitions since the initial advent of agriculture and livestock herding, from ca. 10 000 years ago, occurred when: (i) early agrarian-based settlements enabled sylvatic enzootic microbes to make contact with Homo sapiens; (ii) early Eurasian civilizations (such as the Greek and Roman empires, China and south Asia) came into military and commercial contact, ca. 3000-2000 years ago, swapping their dominant infections; and (iii) European expansionism, over the past five centuries, caused the transoceanic spread of often lethal infectious diseases. This latter transition is best known in relation to the conquest of the Americas by Spanish conquistadores, when the inadvertent spread of measles, smallpox and influenza devastated the Amerindian populations.Today, we are living through the fourth of these great transitional periods. The contemporary spread and increased lability of various infectious diseases, new and old, reflect the combined and increasingly widespread impacts of demographic, environmental, behavioural, technological and other rapid changes in human ecology. Modern clinical medicine has, via blood transfusion, organ transplantation, and the use of hypodermic syringes, created new opportunities for microbes. These have contributed to the rising iatrogenic problems of hepatitis C, HIV/AIDS and several other viral infections. Meanwhile, the injudicious use of antibiotics has been a rare instance of human action actually increasing 'biodiversity'. Another aspect of this fourth transition is that modern hyper-hygienic living restricts microbial exposure in early life. This, in the 1950s, may have contributed to an epidemic of more serious, disabling, poliomyelitis, affecting older children than those affected in earlier, more endemic decades. As with previous human-microbe transitions, a new equilibrial state may lie ahead. However, it certainly will not entail a world free of infectious diseases. Any mature, sustainable, human ecology must come to terms with both the need for, and the needs of, the microbial species that help to make up the interdependent system of life on Earth. Humans and microbes are not "at war"; rather, both parties are engaged in amoral, self-interested, coevolutionary struggle. We need to understand better, and therefore anticipate, the dynamics of that process.

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Etiologies of acute undifferentiated febrile illness in Thailand.

M Chenchittikul, Amorn Leelarasamee, Chanpen Chupaprawan … (2004)

Acute pyrexia of unknown origin (Acute PUO) was reported to affect approximately 200,000-400,000 patients each year reported by the national Annual Epidemiological Surveillance Report. The patients usually present with fever of less than two-week duration and non-specific symptoms such as malaise, myalgia, headache and loss of appetite. Its mortality rate is less than 0.02 percent. It would be interesting to find the etiologies and propose a management plan if the etiologies are discovered. This prospective epidemiologic study aimed to discover the etiologies of acute undifferentiated febrile illness in a tropical region like Thailand. Ten community-based hospitals were chosen as representatives in each part of Thailand to enroll patients into the study. Patients aged over two years old who presented with fever at the participating hospitals during year 1991-1993 were eligible for the study. Entry criteria of acute undifferentiated febrile illnesses (AUFI) included oral temperature over 38.3 degrees C within the last 24 hours, duration of fever ranging from 3-14 days, no specific single organ involvement by history taking and physical examination, normal or non-specific results of the following investigations: complete blood count, thick film for malaria, urinalysis and chest roentgenogram. The patients were hospitalized and a preset diagnostic protocol was performed. Other diagnostic procedures deemed necessary by attending physicians were perform. Patients were followed up within one month after hospital discharge. 1,240 patients were enrolled but only 1,137 case records and results of the serological tests were available for analysis. Etiologies could be found in 471 cases (38.7%). Primary bacteremia was detected in 36 cases (3.2%). E. coli, streptococci, salmonella, Enterobacter spp. and S. aureus were the five most common blood isolates. Serological studies revealed positive results for scrub typhus (7.5%), influenza (6.0%), dengue fever (5.7%), murine typhus (5.3%), enteric fever (1.9%), chikunkunya infection (1.1%), leptospirosis (1.1%) and melioidosis (0.9%). Thirteen cases succumbed (1.1%) in this study. The etiologies in the majority (61.3%) of AUFI remained unknown. Rickettsial infection, influenza and dengue fever are the most common identifiable diseases in a tropical country like Thailand especially during the rainy season. A management guideline for diagnosis and treatment of the AUFI with emphasis on primary bacteremia and antimicrobial-treatable AUFI was proposed.

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Leptospirosis: Enfermedad Zoonótica Emergente

Manuel Céspedes Z (2005)

La leptospirosis es un problema de salud pública a nivel mundial, en particular en áreas tropicales y subtropicales y en países en vías de desarrollo. La magnitud del problema es atribuido a las condiciones climáticas y ambientales, pero también al contacto que se tiene con ambientes contaminados por Leptospira, esto se observa en las actividades agrícolas, ganadera, minera, recreacionales, deportivas y condiciones de salubridad en la vivienda. Es una enfermedad potencialmente mortal pero tratable; su espectro clínico va desde la enfermedad asintomático, síntomas mínimos similares a un resfrió común, hepatitis, dengue clásico o pueden ser graves como las fiebres hemorrágicas virales y meningitis. Al ser frecuente en zonas tropicales donde confluyen otras infecciones como el dengue, tienden a confundirse sus cuadros clínicos, siendo generalmente subdiagnósticada, sin embargo estudios recientes han demostrado su importancia en la salud pública. Los nuevos y menos complicados métodos de diagnóstico se han desarrollado en años recientes, permitiendo que la infección sea identificada en campo sin la necesidad de tener laboratorios tan sofisticados. La falta de disponibilidad de una vacuna que proteja contra todos los serovares de leptospiras hace que la prevención hasta ahora dependa de la implantación de medidas de saneamiento. En esta revisión se brinda información sobre aspectos relacionados a la bacteria, epidemiología, reservorios, transmisión, patogenia, clínica, diagnóstico y manejo de la leptospirosis.