Encefalitis aguda con síndrome cerebeloso secundario a neuroborreliosis / Cerebellar syndrome associated to Lyme neuroborreliosis: case report

La enfermedad de Lyme es la infección transmitida por garrapatas más común en Norteamérica y Europa. Sin embargo, en América Latina se han reportado pocos datos. Borrelia burgdorferi es capaz de invadir el sistema nervioso central causando la neuroborreliosis de Lyme. Se comunica el caso de una mujer joven con encefalitis y síndrome cerebeloso, una presentación poco frecuente, que se manifestó con cefalea, marcha atáxica, nistagmo y ptosis palpebral. Se realizó el diagnóstico con serología positiva por Western blot para Borrelia burgdorferi en suero. Recibió tratamiento con mejoría clínica. El diagnóstico de neuroborreliosis es difícil, ya que no existen hallazgos neurológicos o de imagen específicos. Se recomienda tener un mayor nivel de vigilancia epidemiológica en Latinoamérica, así como los antecedentes recreativos o viajes, que deben incluirse en la historia clínica para mejorar la aproximación diagnóstica.

Lyme disease is the most common tick-borne disease in North America and Europe. However, in Latin America, few data have been reported. Borrelia burgdorferi is capable of invading the central nervous system causing Lyme neuroborreliosis. This is a case report of a female with encephalitis and cerebellar syndrome, a rare manifestation, presented with generalized headache ataxic gait, nystagmus and palpebral ptosis. Serologic diagnosis was made for Borrelia burgdorferi and treatment was initiated with clinical improvement. Neuroborreliosis is a very difficult diagnosis, since there are no neurologic or imaging findings specific. It is recommended to physicians to have an enhanced level of surveillance in Latin America, as well as recreational/travel history of the patient, which should be included in the clinical record to improve the diagnostic approach.

Epidemiology, Outcomes, and Associated Factors of Coronavirus Disease 2019 (COVID-19) Reverse Transcriptase Polymerase Chain Reaction-Confirmed Cases in the San Pedro Sula Metropolitan Area, Honduras.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused substantial morbidity and mortality worldwide. Few reports exist in Latin America, a current epicenter of transmission. Here, we aim to describe the epidemiology and outcomes associated with coronavirus disease 2019 (COVID-19) in Honduras. METHODS: Baseline clinical and epidemiological information of SARS-CoV-2 reverse transcriptase polymerase chain reaction-confirmed cases detected between 17 March-4 May in the San Pedro Sula Metropolitan area was collected; for hospitalized cases, clinical data were abstracted. Logistic regression models were fit to determine the factors associated with hospitalization. RESULTS: We identified 877 COVID-19 cases, of which 25% (n = 220) were hospitalized. The 19-44-year age group (57.8%) and males (61.3%) were predominant in overall COVID-19 cases. Of the cases, 34% (n = 299) had at least 1 preexisting medical condition. Individuals aged 45-69 years (adjusted odds ratio [aOR] = 4.05; 95% confidence interval [CI], 2.85-5.76) or ≥70 years (aOR = 9.12; 95% CI, 5.24-15.86), of male sex (aOR = 1.72; 95% CI, 1.21-2.44), and those with a preexisting condition (aOR = 2.12; 95% CI, 1.43-3.14) had higher odds of hospitalization. Of inpatients, 50% were hospitalized more than 7 days. The median length of hospitalization was 13 days (interquartile range [IQR], 8-29) among individuals aged 19-44 years, and 17 days (IQR, 11-24.6) among those aged 45-69. Of the fatal cases, 42% occurred among adults under 60 years old. CONCLUSIONS: Our findings show that a high proportion of COVID-19 cases in Honduras occurred among younger adults, who also constituted a significant proportion of severe and fatal cases. Preexisting conditions were associated with severe outcomes independently from age and were highly prevalent in Honduran COVID-19 cases.

Antimicrobial profile of Acinetobacter baumannii at a tertiary hospital in Honduras: a cross-sectional analysis

[ABSTRACT]. Acinetobacter baumannii is considered to be a worldwide threat to public health due to its high antimicrobial resistance rates and the severe infections it can cause. Little is known about this pathogen’s resistance in Central America. This report aims to describe the antimicrobial resistance profile of A. baumannii at a tertiary hospital in Honduras. The cross-sectional analysis was conducted at the tertiary care laboratory hospital in San Pedro Sula in 2015 – 2017. A total of 113 consecutive microbiological reports were analyzed, comprising 100 individuals from whom A. baumannii was isolated. Epidemiological and microbiological data, including the isolation setting and patient information, were recorded. Prevalence of multi-drug and extensive-drug resistance was assessed according to international standards. The median age of individuals was 22 years (2 – 35 years); female was the predominant gender (53%). The hospital’s pediatric wards had the highest number of isolates (n = 48). The most frequent specimen from which A. baumannii was isolated was skin and soft tissue (n = 39). Resistance to carbapenems was reported to be 40.7% among the isolates (n = 46); multi-drug resistant, 35.4% (n = 40); and extensively-drug resistant, 7.1% (n = 8). This report reveals the threat of this pathogen to public health in Honduras and appeals for antibiotic stewardship programs throughout Central America.

[RESUMEN]. Acinetobacter baumannii se considera como una amenaza mundial para la salud pública debido a sus tasas elevadas de resistencia a los antimicrobianos y a las infecciones graves que puede causar. Es poco lo que se conoce acerca de la resistencia de este agente patógeno en Centroamérica, por lo que el propósito de este informe es describir el perfil de resistencia a los antimicrobianos de A. baumannii mediante un estudio llevado a cabo en un hospital de atención terciaria en Honduras. Entre el 2015 y el 2017, se realizó un análisis transversal en el laboratorio de atención terciaria en el Instituto Hondureño de Seguridad Social en San Pedro Sula. Se analizó un total de 113 informes de análisis microbiológicos consecutivos, en los que las cepas aisladas de A. Baumannii provenían de un grupo de 100 personas. Se registraron los datos epidemiológicos y microbianos, así como el entorno de aislamiento y la información del paciente. La prevalencia de la multirresistencia y la resistencia extensa se evaluó con base en las normas internacionales. La mediana de edad de las personas fue de 22 años (intervalo: de 2 a 35 años de edad) y predominó el sexo femenino (53%). Las salas de pediatría del hospital presentaron el número más alto de cepas aisladas (n = 48). La piel y el tejido blando (n = 39) fueron las muestras más frecuente de las cuales se aisló la cepa A. Baumannii. Se notificó 40,7% de resistencia a los fármacos carbapenémicos en las cepas aisladas (n = 46); 35,4% de multirresistencia (n = 40); y 7,1% de resistencia extensa (n = 8). Este informe pone en evidencia la amenaza que este agente patógeno representa para la salud pública en Honduras. Asimismo, sirve para alertar a los programas de optimización del uso de antibióticos en Centroamérica.

[RESUMO]. Acinetobacter baumannii é considerado uma ameaça à saúde pública em todo o mundo devido às suas altas taxas de resistência antimicrobiana e às graves infecções que pode causar. Sabe-se pouco sobre a resistência deste patógeno na América Central. Este artigo visa descrever o perfil de resistência antimicrobiana de A. baumannii em um hospital terciário em Honduras. Realizamos uma análise transversal no hospital terciário de San Pedro Sula, de 2015 a 2017. Analisamos um total de 113 laudos microbiológicos consecutivos, que envolveram 100 pessoas das quais foi isolado A. baumannii. Registramos dados epidemiológicos e microbiológicos, incluindo o ambiente onde foi feito o isolamento e informações sobre os pacientes. Avaliamos a prevalência de resistência a múltiplos fármacos e resistência extensiva, de acordo com padrões internacionais. A idade mediana dos participantes foi de 22 anos (intervalo, 2 a 35 anos); a maioria dos participantes foi do sexo feminino (53%). As enfermarias pediátricas do hospital tiveram o maior número de isolados (n = 48). A pele e os tecidos moles foram os espécimes mais frequentes de isolamento de A. baumannii (n = 39). A resistência aos carbapenens foi constatada em 40,7% dos isolados (n = 46), a resistência a múltiplos fármacos esteve presente em 35,4% (n = 40) e a resistência extensiva em 7,1% (n = 8). Este artigo revela a ameaça que este patógeno representa à saúde pública em Honduras e faz um apelo pela implantação de programas de gestão do uso de antibióticos em toda a América Central.