RESUMO
RESUMEN Se presenta el caso de una mujer de 19 años con 29 semanas de gestación, procedente de Llumpe (Ancash) con antecedentes de viajes a las localidades de Chanchamayo (Junín) y Rinconada (Ancash). Ingresó al Hospital de Chacas (Ancash) por presentar mal estado general, deshidratación, dificultad respiratoria, ictericia, sensación de alza térmica y dolor abdominal, tuvo reporte de: hemoparásitos 60% en frotis sanguíneo. Fue transferida al Hospital Ramos Guardia (Huaraz) donde presentó mayor dificultad respiratoria, coluria, hematuria, disminución del débito urinario y reporte de Plasmodium (+), luego fue transferida al Hospital Cayetano Heredia (Lima) donde ingresó a la Unidad de Cuidados Intensivos (UCI), con evolución a falla multiorgánica, óbito fetal y muerte materna. Se confirmó infección por Plasmodium vivax. Destacamos la importancia de mejorar nuestras capacidades de diagnóstico y manejo para brindar un tratamiento adecuado y oportuno.
ABSTRACT Here we describe the case of a 19-year-old woman, in her 29th week of gestation, who was from Llumpe (Ancash, Peru) and had a history of traveling to Chanchamayo (Junín, Peru) and Rinconada (Ancash, Peru). The patient presented at Chacas Hospital (Chacas, Ancash, Peru) with general malaise, dehydration, respiratory distress, jaundice, the sensation of thermal rise, and abdominal pain. Analysis of blood smears revealed 60% hemoparasites. She was transferred to Ramos Guardia Hospital (Huaraz, Peru) where she presented increasing respiratory distress, choluria, hematuria, and decreased urine output, moreover she was positive for Plasmodium. From there she was transferred to Cayetano Heredia Hospital (Lima, Peru), where she was admitted to the intensive care unit (ICU) with multiple organ failure, stillbirth, and leading to death. She underwent mechanical ventilation, was administered clindamycin, and was prescribed quinine, which she did not received due a lack by availability. The evolution of the illness was torpid, and she ultimately developed multiple organ failure and died. Plasmodium vivax infection was confirmed. Accordingly, we emphasize the importance of improving our diagnostic capabilities and management techniques to enable clinicians to provide adequate and timely treatment.
Assuntos
Adulto , Feminino , Humanos , Gravidez , Adulto Jovem , Plasmodium vivax , Complicações Infecciosas na Gravidez , Malária Vivax , Morte Materna , Peru , Evolução Fatal , MaláriaRESUMO
La transmisión nosocomial de la tuberculosis (TB) es un problema vigente en el Perú, tanto por el riesgo de enfermar que corre el personal de salud y pacientes, como por la presencia cada vez más frecuente de cepas resistentes: TB MDR (multidrogo resistente), TB XDR (extensivamente resistente a drogas). Se describen los factores condicionantes de la transmisión de TB en los hospitales, así como las medidas de control recomendadas, incluyendo: 1) control administrativo, 2) control ambiental y 3) protección respiratoria personal. Además, se señala la importancia de los Planes de Control deInfecciones de Tuberculosis en los hospitales y la experiencia en su implementación en 19 centros hospitalarios del país.
Nosocomial transmission of tuberculosis (TB) is a current problem in Peru, on the one hand because of the risk for healthpersonal and for inpatients to acquire the infection, and on the other because of the increasing frequency of resistant strains: MDR (multidrug resistant) TB, XDR (extensively drug resistant) TB. Factors conditioning transmission of tuberculosis in hospitals are described, as well as recommended control measures, including: 1) administrative control, 2) environmental control, and 3) personal respiratory protection. Furthermore, the importance of the Plans of Tuberculosis Infection Control inhospitals is stressed and experience in its implementation in 19 hospital centers in the country is addressed.