Co-infección por los virus del dengue y chikungunya: revisión narrativa / Coinfection of dengue and chikungunya viruses: narrative review

Resumen Introducción: Los virus del dengue y chikungunya son transmitidos por la hembra de los mosquitos Aedes aegypti y Aedes albopictus, ampliamente distribuidos en zonas tropicales y subtropicales, lo que facilita la co-infección. Objetivo: Determinar la magnitud, la distribución geográfica y el cuadro clínico de la co-infección por dengue y chikungunya. Material y Métodos: Revisión narrativa. Búsqueda en las bases de datos PubMed y Lilacs, utilizando los términos MeSH "Chikungunya", "CHIKV", "DENV", "Dengue" y "coinfection. Se incluyeron los artículos de los últimos 20 años. Resultados: Se incluyeron 45 artículos. El mayor reporte de co-infección fue en Asia seguido de África. En las Américas la información es limitada por la reciente circulación del chikungunya. La magnitud de la co-infección varió entre 0 y 31,9%. No se encontraron diferencias en la distribución de la co-infección por sexo y edad. El cuadro clínico de la mono-infección y la co-infección fue similar. Algunos reportes de caso exponen cuadros graves con afección del sistema nervioso central, manifestaciones hemorrágicas y enfermedad de Still. Conclusión: Las manifestaciones clínicas de la co-infección por dengue y chikungunya son similares a la mono-infección, situación que dificulta el diagnóstico y la medición de su magnitud.

Background: Dengue and chikungunya viruses are transmitted by the female Aedes aegypti and Aedes albopictus, which are widely distributed in tropical and subtropical areas, facilitating coinfection. Aim: To determine the magnitude, geographical distribution and clinical picture of dengue and chikungunya coinfection. Material and Methods: Narrative review. A search in the PubMed and Lilacs databases was made, using the MeSH terms "Chikungunya", "CHIKV", "DENV", "Dengue" and "coinfection. The articles of the last 20 years were included. Results: A total of 45 articles were included. The largest coinfection report was in Asia followed by Africa. In the Americas, the information is limited because of the recent circulation of chikungunya. The magnitude of coinfection varies between 0% and 31.9%. No differences were found in the distribution of coinfection by sex and age. The clinical picture of monoinfection and coinfection was similar. Some case reports show severe cases with central nervous system involvement, hemorrhagic manifestations and Still's disease. Conclusion: The clinical manifestations of coinfection by dengue and chikungunya viruses are similar to those due to monoinfection, which difficult the diagnosis and measurement of its magnitude.

Barriers to control syphilis and HIV vertical transmission in the health care system in the city of Sao Paulo / Entraves no controle da transmissão vertical da sífilis e do HIV no sistema de atenção à saúde do município de São Paulo

OBJECTIVE: The objective of this study was to identify possible barriers to control vertical transmission of syphilis and HIV through the analysis of the orientation process of pregnant women from prenatal care to the obstetric center at an university hospital in Sao Paulo (Reference) and their return (with their exposed babies) for follow-up after hospital discharge (counter-reference). METHODS: It is a retrospective cross-sectional study including interviews with healthcare personnel. Pregnant women with syphilis and/or HIV-infection admitted for labor or miscarriage were identified from August 2006 to August 2007. Routine care for mothers and babies were analyzed. RESULTS: 56 pregnant women were identified: 43 were HIV-infected, 11 had syphilis and two were coinfected (syphilis/HIV); 22 health care professionals were interviewed. Prenatal care was identified in 91.1% of these women: 7/11 (63.6%) with syphilis; 44/45 (97.8%) HIV-infected or coinfected. The reference for delivery was satisfactory for 57.7% of the syphilis-infected women and 97.7% of the HIV-infected ones. The counter-reference was satisfactory for all babies and mothers at hospital discharge, besides the non-adherence to this recommendation. Interviews with health care professionals showed there are better routines for assisting and following-up pregnant women, puerperal women and HIV-infected or exposed babies than for those infected with syphilis. The epidemiological report and surveillance system are also better for HIV-infected patients. CONCLUSION: The difficulties in the reference and counter-reference system of these women and their babies are evident barriers to control the vertical transmission of these infectious diseases. .

OBJETIVO: O objetivo deste estudo foi identificar possíveis entraves ao controle da transmissão vertical da sífilis e HIV através da análise do processo de encaminhamento das gestantes desde os serviços de atendimento pré-natal até o Centro Obstétrico de um hospital universitário, no município de São Paulo (referência), e seu retorno, com seus bebês expostos, após alta hospitalar, para acompanhamento (contrarreferência). MÉTODO: Estudo de corte transversal, retrospectivo, acrescido de entrevistas com profissionais de saúde. Gestantes com sífilis e/ou infecção pelo HIV foram identificadas na admissão para o parto de agosto de 2006 a agosto de 2007. A rotina e o fluxo dos encaminhamentos de mães e recém-nascidos foram analisados. RESULTADOS: Foram identificadas 56 gestantes infectadas: 43 com infecção pelo HIV, 11 com sífilis e duas coinfectadas (sífilis/HIV); 22 profissionais de saúde foram entrevistados. Acompanhamento pré-natal foi feito por 91,1% das mulheres: 7/11 (63,6%) com sífilis; 44/45 (97,8%) infectadas pelo HIV ou coinfectadas. A referência para o parto foi adequada para 57,1% das gestantes com sífilis e 97,7% daquelas infectadas pelo HIV. A contrarreferência foi adequada para todas as gestantes, apesar da não aderência a essa recomendação. Entrevistas com os profissionais de saúde revelaram que as rotinas e o fluxo de encaminhamento das gestantes, puérperas e recém-nascidos estão mais bem estabelecidos para HIV do que para sífilis. A vigilância epidemiológica e notificação também foram mais eficazes para o HIV. CONCLUSÃO: As dificuldades no sistema de referência e contrarreferência dessas mulheres e seus bebês são evidentes entraves ao controle da t...

Prevalencia de Trichomonas vaginalis en trabajadores sexuales / Trichomonas vaginalis prevalence in sex workers

La tricomoniasis es una infección de transmisión sexual (ITS) que se asocia a vaginitis, uretritis, cervicitis y enfermedad inflamatoria pélvica pudiendo producir infertilidad tubárica. El objetivo de este trabajo, de tipo retrospectivo longitudinal, fue determinar la prevalencia de Trichomonas vaginalis en una población de trabajadores sexuales en Mendoza, Argentina. Se estudió en forma retrospectiva una población de 720 personas asistidas por el Programa Provincial de ITS de Mendoza. Entre febrero de 2007 y junio de 2009 se procesaron 1692 muestras con un muestreo por reposición. La distribución por sexo fue de 687 mujeres y 33 varones con edades comprendidas entre 15 y 65 años. La prevalencia de tricomoniasis determinada en esta población en riesgo fue de 7.6% para las mujeres, sin encontrarse infecciones en el grupo de los hombres. La prevalencia hallada en este grupo en riesgo muestra una población con alta vulnerabilidad para contraer otras ITS de mayor gravedad. En otro sentido, sugiere una importante falta de adhesión al uso de barreras mecánicas para prevenir infecciones de transmisión sexual. Este trabajo justifica la elaboración de una guía de procedimientos para el manejo de la infección por tricomonas en el marco del Programa de Salud Reproductiva (PROSAR).

Trichomoniasis is a sexually transmitted infection (STI) usually associated to vaginitis, urethritis, cervicitis and pelvic inflammatory disease, which can cause infertility. The aim of this retrospective longitudinal study was to determine Trichomonas vaginalis prevalence in a population of male and female sex workers in Mendoza, Argentina. A cohort of 720 people who attended the STI Program in this province was retrospectively analyzed. From February 2007 up to June 2009, 1692 samples were processed using a reposition sampling method. The age and sex distribution of the population was: 687 women/33 men, from 15 to 65 years old. Trichomoniasis prevalence determined for this population at risk was 7.6% in women only, men did not present infection. The high prevalence shown for this risk group suggests a great vulnerability of this population to contract other more serious STIs. In another sense, it also shows a remarkable lack in the use of mechanical barriers to prevent sexually transmitted diseases (STDs). The present research justifies the elaboration of standardized procedures guide to diagnose T. vaginalis within the framework of the Reproductive Health Program (PROSAR).