Subject(s)
Male , Humans , Adult , Takayasu Arteritis/diagnosis , Takayasu Arteritis/therapy , Foot UlcerABSTRACT
Introducción: la enfermedad de Carrión es una enfermedad re-emergenteen el Perú y presenta diversas complicaciones infecciosas y no infecciosas. Objetivo: Evaluar las complicaciones cardiovasculares (CC) en la fase aguda de la enfermedadMétodos: Estudio observacional realizado en el Hospital Nacional Cayetano Heredia (HNCH) desde 1987-2007. Ingresaron pacientes adultos con el diagnóstico confirmado de Bartonelosis. esultados: De los 68 pacientes incluidos 52 fueron masculinos y 16 femeninos, la edad media fue 25,7 años. Ninguno tuvo enfermedad cardiovascular previa. Los principales hallazgos clínicos fueron: fiebre (99%), hepatomegalia (79%), ictericia (74%), taquicardia (74%), taquipnea 71%), soplo sistólico (68%), disnea (62%), reflujo hepatoyugular (19%) e ingurgitación yugular (15%). 64 radiografías de tórax evaluadas mostraron: 44% cardiomegalia, 20% congestión pulmonar, y 16% derramepleural. Conclusión: las CC son frecuentes en la bartonelosis. Diversos síndromes cardiovasculares fueron observados, y se asociaron a menor tiempo de enfermedad, mayor estancia ospitalaria, mayor uso de cloramfenicol (Caf) y menor de ciprofloxacina (Cip), mayor frecuencia de complicacionesinfecciosas y más admisiones a la UCI, pero no mayor mortalidad.
Introduction: Carrion's disease is considered a re-emerging disease in Peru, and it leads to several non-infectious and infectious complications.Objectives: To assess cardiovascular complications (CC) during the acute phase of this disease.Methods: An observational study was conducted at Cayetano Heredia Hospital (HNCH) from 1987 to 2007. Adult patients with a confirmed diagnosis of Bartonellosis were included. Results: 68 patients were included (52 males, mean age 25,7 years). No one had prior cardiovascular disease. Main clinical findings were: fever (99%), hepatomegaly (79%), jaundice (74 per cent), tachycardia (74%), tachypnea (71%), systolic murmur (68%), dyspnea (62%), hepatojugular reflux (19%) and jugular ingurgitation (15%). Sixty-four chest X-ray films showed the following findings: 44% cardiomegaly, 20% pulmonary congestion, and 16% pleural effusion. Transthoracic echocardiogram was performed in 42 patients: 38% had pericardial effusion, 19% dilated left atrium, and 17% dilated left ventricle. Thirty-six patients developed CC: congestive heart failure was found in 92%, effusive pericarditis in 44%, acute pulmonary edema in 36%, cardiogenic shock in 17%, pericardiac tamponade in 11% and myocarditis in 11%. Patients who developed CC had a shorter time of illness before admission (p= 0.01), stayed longer in the hospital (p= 0.014), used more chloramphenicol (p= 0.009) and less ciprofloxacin (p= 0.004), they developed more infectious complications (p= 0.002), and they were more frequently admitted in the ICU (p= 0.004), compared to patients who did not develop CC.Conclusion: CC are frequent in Bartonellosis. A variety of cardiovascular syndromes was observed, and they were associated to a shorter time of illness before admission, longer hospitalizations ...