Tropical infections in the ICU.

Certain arthropod-borne infections are common in tropical regions because of favorable climatic conditions. Water-borne infections like leptospirosis are common due to contamination of water especially during the monsoon floods. Infections like malaria, leptospirosis, dengue fever and typhus sometimes cause life threatening organ dysfunction and have several overlapping features. Most patients present with classicial clinical syndromes: fever and thrombocytopenia are common in dengue, malaria and leptospirosis; coagulopathy is frequent in leptospirosis and viral hepatitis. Hepatorenal syndrome is seen in leptospirosis, falciparum malaria and scrub typhus. The pulmonary renal syndrome is caused by falciparium malaria, leptospirosis, Hantavirus infection and scrub typhus. Fever with altered mental status is produced by bacterial meningitis, Japanese B encephalitis, cerebral malarial, typhoid encephalopathy and fulminant hepatic failure due to viral hepatitis. Subtle differences in features of the organ failure exist among these infections. The diagnosis in some of these diseases is made by demonstration of antibodies in serum, and these may be negative in the first week of the illness. Hence empiric therapy for more than one disorder may be justified in a small proportion of cases. In addition to specific anti-infective therapy, management of organ dysfunction includes use of mechanical ventilation, vasopressor drugs, continuous renal replacement therapy and blood products. Timely transfer of these patients to well-equipped ICUs with experience in managing these cases can considerably decrease mortality and morbidity.

Tifus exantemático / Exanthematous typhus

Contiene: 1. Microbiología; 2. Patogenia/fisiopatología; 3. Anatomía patológica; 4. Aspectos epidemiológicos; 5. Diagnóstico de laboratorio; 6. Diagnóstico diferencial; 7. Procedimientos para la vigilancia epidemiológica; 8. Medidas de prevención y control

Fiebre tifoidea en Cartagena / Typhoid fever in Cartagena

Se revisaron 92 historias con diagnostico de fiebre tifoidea comprobada bacteriologicamente que se presentaron en el Hospital Universitario de Cartagena en el periodo comprendido entre enero de 1976 y diciembre de 1987. Se describen los hallazgos epidemiologicos, sintomas, signos, examenes de laboratorio y tratamiento. Se comparan estos resultados ( de una forma endemica de la enfermedad) con otros tres estudios colombianos, encontrando diferencias entre las formas epidemicas y endemicas. Se dicuten nuevos metodos diagnosticos (serologicos) y modalidades terapeuticas prometedoras