Fiebre Q: una zoonosis olvidada en Colombia / Q fever: a neglected zoonosis in Colombia

La fiebre Q es una zoonosis ampliamente distribuida, capaz de provocar innumerables pérdidas económicas en rumiantes domésticos (ovinos, caprinos y bovinos). En humanos se presenta con gran versatilidad de manifestaciones clínicas; más de la mitad de los casos suelen ser asintomáticos, la infección aguda generalmente se presenta como una enfermedad febril no específica, con gran potencial para desarrollar neumonía, hepatitis y endocarditis crónica. En la mayoría de países latinoamericanos la fiebre Q es una enfermedad olvidada, principalmente por el desconocimiento y falta de asociación epidemiológica por parte de profesionales de la salud, sumado a la carencia de herramientas de diagnóstico preciso y asequible, que como consecuencia, influencian en el subreporte y subdiagnóstico de la enfermedad. El objetivo de esta revisión fue describir los aspectos clínicos, eco-epidemiológicos, diagnóstico y tratamiento de la fiebre Q. Se utilizó una búsqueda sistemática de artículos, los cuales fueron revisados y evaluados críticamente de acuerdo a su calidad, basado en el rigor científico, credibilidad, relevancia y aplicabilidad de los resultados sobre los temas abordados a fin de proveer una actualización y profundización en el conocimiento de la enfermedad.

Q fever is a widespread zoonosis able to cause countless economic losses in domestic ruminants (sheep, goats and cattle). In humans occurs with great versatility of clinical manifestations; more than half of the cases are often asymptomatic, acute infection usually presents as a nonspecific febrile illness, with great potential to develop pneumonia, hepatitis and chronic endocarditis. In most of Latin American countries, Q fever is a neglected disease, mainly due to lack of knowledge and epidemiological association of health professionals, added to the absence of accurate diagnostic tools, which influence the subreport and misdiagnosis of the disease. In this context, the aim of this review was to describe the clinical aspects, eco-epidemiology, diagnosis and treatment of Q fever. Was used a systematic search for items, which were critically reviewed and evaluated according to their quality, based on scientific rigor, credibility, relevance and applicability of the results on the subjects covered, in order to provide an update and further knowledge of the disease.

Apresentação clínica e evolução de pacientes com infecção por Influenza A (H1N1) que necessitaram de terapia intensiva durante a pandemia de 2009 / Influenza A (H1N1) patients admitted to intensive care units during the 2009 pandemics: clinical features and outcomes

OBJETIVOS: Descrever a apresentação clínica e a evolução dos pacientes admitidos com diagnóstico de infecção por influenza pandêmica (H1N1) em duas unidades de terapia intensiva de hospitais privados de São Paulo. MÉTODOS: Foi realizada coorte retrospectiva com a avaliação de dados demográficos, da apresentação clínica inicial, escores prognósticos [Simplified Acute Physiology Score (SAPS) 3 e Sequential Organ Failure Assessment (SOFA)], comorbidades, de evolução e de tratamento de todos os pacientes que foram admitidos com diagnóstico confirmado de infecção por influenza pandêmico entre Julho e Setembro de 2009. RESULTADOS: Durante o período analisado, foram admitidos 22 pacientes. A mediana de idade foi de 30 (25-43,5) anos. As medianas do SAPS 3 e do SOFA foram, respectivamente de 42 (37-49) e 2 (1-3,5). Comorbidades foram comuns (50 por cento), especialmente a obesidade (22,7 por cento). Duas (9,1 por cento) pacientes eram gestantes. Cinco (22,7 por cento) pacientes foram submetidos à ventilação mecânica, mas houve necessidade de altas pressões expiratórias nestes (mediana de 16cm H2O e intervalos interquartis 10-25cmH2O). A taxa de falha de ventilação não-invasiva foi de 50 por cento. A maior parte (77,2 por cento) dos pacientes foi tratada com oseltamivir. A mortalidade hospitalar foi de 4,5 por cento. SAPS 3, SOFA e relação PaO2/FiO2 iniciais associaram-se com a necessidade de ventilação mecânica (p<0,01). CONCLUSÕES: A infecção por influenza pandêmico acometeu principalmente indivíduos jovens, especialmente obesos. Neste estudo, os pacientes eram menos graves que os descritos anteriormente, o que explica as menores mortalidade e necessidade de ventilação mecânica. No entanto, uma necessidade de altas pressões expiratórias nos pacientes que precisaram de ventilação mecânica.

OBJECTIVES: To describe the clinical features and outcomes of patients admitted with influenza A (H1N1) infection in two private hospitals' intensive care units in São Paulo, Brazil, during the 2009 pandemics. METHODS: A retrospective cohort study was conducted to evaluate demographic data, initial clinical presentation, prognostic scores [Simplified Acute Physiology Score (SAPS) 3 and Sequential Organ Failure Assessment (SOFA)], comorbidities, outcomes and treatment of patients with confirmed pandemic influenza diagnosis from July to September 2009. RESULTS: 22 patients were admitted. Median age was 30 (25-43.5) years. Median SAPS 3 and SOFA were 42 (37-49) and 2 (1-3.5), respectively. Comorbidities were common (45.4 percent), especially obesity (22.7 percent). Two (9.1 percent) patients were pregnant. Five (22.7 percent) patients required invasive mechanical ventilation, with high positive end expiratory pressures (median of 16 cmH2O, interquartile range 10-25cmH2O). There was a 50 percent incidence of non-invasive ventilation failure. Most (77.2 percent) of patients were treated with oseltamivir. Hospital mortality was 4.5 percent. Initial SAPS 3, SOFA and PaO2/FiO2 ratio were associated with mechanical ventilation requirement (p<0.01). CONCLUSIONS: Pandemic influenza infection mainly affected young and obese patients. In this study, patients were less severe than those previously described, what explains our low mortality and mechanical ventilation needs. However, high positive end expiratory pressures were required for mechanically ventilated patients.

Simulación de un brote de enfermedad respiratoria aguda en el municipio de Camagüey / Simulation of an acute respiratory disease outbreak in Camagüey municipality

Fundamento: Los modelos matemáticos constituyen una herramienta poderosa para modelar procesos de la realidad, sus resultados son de gran utilidad para optimizar los recursos, que generalmente están limitados , con ellos se pueden dirigir medidas más efectivas que aumenten la comprensión del fenómeno en estudio, estos deben ser tan simples como sea posible, pero deben ser precisos flexibles y transparentes. Objetivo: Realizar simulaciones con el modelo SIR que se pretende introducir fundamentalmente en la docencia, en los análisis epidemiológicos y en la toma de decisiones. Método: Se analizan en el municipio Camagüey los casos de Enfermedades respiratorias agudas del año 2007, se reportaron ciento sesenta mil cuatrocientos veintidós casos, la población al cierre de ese año fue de 788 058 habitantes. En este modelo, “Susceptibles, Infectados y Recuperados”, S+R+I= N, donde N es el total de la población, (?) es el índice de transmisibilidad y (?) el índice de recuperación. Todas estas fórmulas se implementaron en el programa Matlab versión 7,4 del 2006. Resultados: Se muestran diferentes comportamientos para una población sin inmunidad, para esa misma población con la mitad inmunizada y para la situación inicial con aislamiento de enfermos al quinto día del brote epidémico. Se muestran comportamientos diferentes para tres índices de transmisibilidad diferentes. Conclusiones: Es posible utilizar el modelo “Susceptibles, Infectados y Recuperados” para la docencia y para los análisis epidemiológicos y tener en cuenta el indicador llamado “número reproductivo básico”, el cual nos indica los casos secundarios que genera un caso primario, y constituye en la Epidemiología moderna un indicador del avance de las medidas de control y de la severidad de las epidemias.

Background: The mathematical models constitute a powerful tool to model reality processes, their results are of great utility to optimize the resources that are generally limited, with them may direct effective measures that increase the understanding of the phenomenon in study, these should be as simple as it is possible, but should be precise, flexible and transparent. Objective: To carry out simulations with the SIR pattern that is pretend to introduce fundamentally in teaching, in the epidemic analyses and when taking decisions. Methods: The cases of acute respiratory diseases of the year 2007 in Camagüey municipality, are analyzed, 160 422 cases were reported, the population at the end of that year was about 788 058 inhabitants, In this model, "Susceptible, Infected and Recovered", S+R+I=N, where N is the population's total, (?) is the transmissibility index and (Y) the recovery index. All these formulas were carried out in the Matlab version 7,4 program of the 2006. Results: Different behaviors are shown for a population without immunity, for the same population with the half immunized and for the initial situation with the sickpeople isolation at the fifth day of the epidemic outbreak. Different behaviors are shown for three different transmissibility indexes. Conclusions: It is possible to use the "Susceptible, Infected and Recovered" pattern, for teaching and for the epidemic analyses and to keep in mind the indicator called "basic reproductive number", the one which indicates us the secondary cases that generates a primary case, and it constitutes in the modern Epidemiology an indicator of the advance of the control measures and the severity of epidemics.