ABSTRACT
The Chikungunya is an arbovirus first described during a 1952 outbreak of febrile exantematic disease in southern Tanganyika (now Tanzania). It is a virus within the alphavirus genus of the Togaviridae family, it is usually transmitted to humans by Aedes mosquitoes. Typically, the disease manifests as acute onset of fever and joint pains. This study describes the clinical characteristics the first imported case infected with chikungunya fever (CHIK) in Hermosillo, Sonora, Mexico. We report the case of a 30 years old man seen in our emergency department due to fever, polyarthralgia, rash and headache. This patient has been in Tapachula, Chiapas, a jungle area in southern México, and he returned from a 45 days trip before the onset his symptoms. The chikungunya viral infection (CHIK) was diagnosed by RT-PCR procedure. Paracetamol therapy was administered and his clinical course was self-limited. We concluded that with the increase of mosquito´s habitat by global warming and frequent traveling, CHIK reemerged and showed global distribution recently. This disease must be suspected in patients with compatible clinical symptoms returning from epidemic/endemic areas. CHIK must be diagnosed on the basis of clinical, epidemiological and laboratory criteria.
El virus de chikunguña es un arbovirus descrito en 1952 durante un brote de enfermedad febril exantemática en Tangañica. Es un virus del genero alfavirus, de la familia Togaviridae, transmitido a los humanos por los mosquitos Aedes. Típicamente la enfermedad se caracteriza por fiebre de inicio súbito y artralgias. Este estudio describe las características clínicas del primer caso importado con fiebre chikunguña (CHIK) en Hermosillo, Sonora, México. Se presenta el caso de un paciente de 30 años de edad, atendido en el servicio de Urgencias por fiebre, poliartralgias, cefalea y exantema. El paciente había visitado la ciudad de Tapachula, Chiapas por un período de 45 días antes del inicio de sus síntomas. La CHIK fue confirmada mediante RT-PCR, por lo que fue tratado con paracetamol; su evolución clínica fue satisfactoria y autolimitada. Con el incremento del hábitat del vector debido al calentamiento global y a la mayor frecuencia de viajes, se ha registrado una reemergencia global de la CHIK. Este padecimiento debe sospecharse en pacientes con características clínicas sugestivas que regresan de áreas epidémicas/endémicas. El diagnóstico de CHIK requiere el sustento de los datos clínico-epidemiológicos y del criterio por laboratorio.
Subject(s)
Chikungunya Fever/diagnosis , Adult , Humans , Male , MexicoABSTRACT
BACKGROUND: Rocky Mountain spotted fever is a life threatening disease caused by Rickettsia rickettsia, characterized by multisystem involvement. METHODS: We studied 19 dead children with Rocky Mountain spotted fever. All children who were suspected of having rickettsial infections were defined as having Rocky Mountain spotted fever by serology test and clinical features. Through the analysis of each case, we identified the clinical profile and complications associated to the death of a patient. RESULTS: In nine (69.2%) of 13 cases that died in the first three days of admission, the associated condition was septic shock. Others complications included respiratory distress causes by non-cardiogenic pulmonary edema, renal impairment, and multiple organ damage. CONCLUSIONS: The main cause of death in this study was septic shock. The fatality rate from Rocky Mountain spotted fever can be related to the severity of the infection, delay in diagnosis, and delay in initiation of antibiotic therapy. Pulmonary edema and cerebral edema can be usually precipitated by administration of excess intravenous fluids.
Subject(s)
Rickettsia rickettsii , Rocky Mountain Spotted Fever/mortality , Shock, Septic/mortality , Adolescent , Cause of Death , Child , Child, Preschool , Female , Humans , Infant , Male , Mexico , Retrospective Studies , Rocky Mountain Spotted Fever/complications , Rocky Mountain Spotted Fever/diagnosisABSTRACT
Objetivo. Evaluar el signo del cabeceo como indicador de hipoxemia en ninos con neumonia. Material y metodos. Se estudiaron 62 menores de 5 anos de edad. Se definio hipoxemia a la saturacion de oxigeno <94 por ciento registrada mediante oximetria de pulso. La validez del signo se evaluo mediante tres puntos de corte (<94 por ciento, . 90 por ciento, . 84 por ciento). Resultados. La prevalencia de hipoxemia fue de 56.5 por ciento. El cabeceo se encontro en 40 (64.5 por ciento) pacientes, de ellos, 30 tenian neumonia y 73.1 por ciento presentaba hipoxemia. El cabeceo mostro una sensibilidad de 73.2 por ciento y una especificidad de 52.4 por ciento. La precision del signo fue mayor al usar el nivel de corte <94 por ciento. El cabeceo fue un mejor indice de hipoxemia en ninos menores de 1 ano. Conclusiones. El cabeceo es un buen predictor de hipoxemia en ninos con neumonia. Es un signo facilmente reconocible que puede ser ensenado a padres y trabajadores de la salud.
Objective. To assess the clinical usefulness of the head nodding sign (HN) in children with pneumonia. Material and Methods. Cross-sectional study that included 62 children aged 2-59 months. Hypoxemia was defined as arterial oxygen saturation <94 percent measured by pulse oximetry. HN was examined with regard to three levels of hypoxemia (<94 percent, . 90 percent, . 84 percent). Results. The overall prevalence of hypoxemia was 56.5 percent. HN was observed in 64.5 percent (40) of the patients, 48.4 percent (30) of those had pneumonia and 73.1 percent were hypoxemic. HN showed a sensitivity of 73.2 percent and a specificity of 52.4 percent. Accuracy of HN was better when a cut off level <94 percent was used. HN in infants was a better index for hypoxemia than for older children. Conclusions. HN was a good predictor of hypoxemia in children with pneumonia. It seems that HN is an easily recognizable sign, and it could be easily taught to parents and health workers.
Subject(s)
Child, Preschool , Female , Humans , Infant , Male , Hypoxia/diagnosis , Hypoxia/etiology , Head Movements , Pneumonia/complications , Cross-Sectional Studies , Reproducibility of ResultsABSTRACT
OBJECTIVE: To assess the clinical usefulness of the head nodding sign (HN) in children with pneumonia. MATERIAL AND METHODS: Cross-sectional study that included 62 children aged 2-59 months. Hypoxemia was defined as arterial oxygen saturation <94% measured by pulse oximetry. HN was examined with regard to three levels of hypoxemia (<94%, Subject(s)
Head Movements
, Hypoxia/diagnosis
, Hypoxia/etiology
, Pneumonia/complications
, Child, Preschool
, Cross-Sectional Studies
, Female
, Humans
, Infant
, Male
, Reproducibility of Results
ABSTRACT
OBJECTIVE: To report the clinical features of the Rocky Mountain spotted fever (RMSF) in children of southern Sonora, Mexico. MATERIAL AND METHODS: Nine cases were studied at the Sonora State Children's Hospital. One case was defined by clinical features and positive serological tests (indirect immunofluorescence assay or reaction to Proteus OX 19). Demographic and clinical characteristics of the patients were registered. RESULTS: The study subjects were children from two to twelve years ofage. All patients have had contact with tick-infested dogs and had fever, as well as petechial rash. Laboratory findings included high levels of hepatic aminotransferase, hyponatremia and thrombocytopenia. Therapy with chloramphenicol and doxyciclyne was administered after the first seven days of the onset of illness. The mortality rate was 22%. CONCLUSIONS: This study supports the presence of RMSF in the state of Sonora, Mexico, which should be considered as a public health hazard, requiring immediate actions for prevention and control.
Subject(s)
Rocky Mountain Spotted Fever/diagnosis , Animals , Anti-Bacterial Agents/therapeutic use , Bites and Stings/complications , Child , Child, Preschool , Chloramphenicol/therapeutic use , Dogs/parasitology , Doxycycline/therapeutic use , Female , Humans , Male , Mexico/epidemiology , Rocky Mountain Spotted Fever/drug therapy , Rocky Mountain Spotted Fever/mortality , TicksABSTRACT
Objetivo. Comunicar las características clínicas de la fiebre manchada de las Montañas Rocosas (FMMR) en niños del sur de Sonora, México. Material y métodos. Se realizó un estudio de nueve casos atendidos en el Hospital Infantil del estado de Sonora. Un caso de FMMR fue definido por datos clínicos y pruebas serológicas positivas (inmunofluorescencia indirecta o aglutinación a Proteus OX 19). Se recabaron las características clínicas y demográficas de los pacientes. Resultados. La población de estudio se integró con niños de dos a doce años de edad que tuvieron contacto con perros infestados con garrapatas y cursaron con fiebre y exantema petequial. Las alteraciones en los exámenes de laboratorio incluyeron elevación de enzimas hepáticas, hiponatremia y plaquetopenia. El tratamiento consistió en la administración de cloranfenicol y doxiciclina. La mortalidad fue del 22%. Conclusión. Se documenta la presencia de la enfermedad en el estado de Sonora, México. La FMMR debe considerarse como un riesgo de salud pública que requiere acciones para su prevención y control.
OBJECTIVE: To report the clinical features of the Rocky Mountain spotted fever (RMSF) in children of southern Sonora, Mexico. MATERIAL AND METHODS: Nine cases were studied at the Sonora State Children's Hospital. One case was defined by clinical features and positive serological tests (indirect immunofluorescence assay or reaction to Proteus OX 19). Demographic and clinical characteristics of the patients were registered. RESULTS: The study subjects were children from two to twelve years ofage. All patients have had contact with tick-infested dogs and had fever, as well as petechial rash. Laboratory findings included high levels of hepatic aminotransferase, hyponatremia and thrombocytopenia. Therapy with chloramphenicol and doxyciclyne was administered after the first seven days of the onset of illness. The mortality rate was 22%. CONCLUSIONS: This study supports the presence of RMSF in the state of Sonora, Mexico, which should be considered as a public health hazard, requiring immediate actions for prevention and control.
Subject(s)
Humans , Animals , Male , Female , Child, Preschool , Child , Rocky Mountain Spotted Fever/diagnosis , Anti-Bacterial Agents/therapeutic use , Dogs/parasitology , Chloramphenicol/therapeutic use , Doxycycline/therapeutic use , Rocky Mountain Spotted Fever/drug therapy , Rocky Mountain Spotted Fever/mortality , Mexico/epidemiology , Bites and Stings/complications , TicksABSTRACT
Rocky Mountain spotted fever (RMSF) is an acute febrile illness caused by infection with Ricketsia Rickettsii, characterized by the presence of petechial rash. Even though the etiology, clinical characteristics and availability of effective antibiotics are known, RMSF related deaths have a prevalence of 4%. In its early stages RMFS can resemble many others infectious conditions and the diagnosis can be difficult. The present paper reports two patients with RMSF; these cases underscore the importance of prompt diagnosis and appropriate antimicrobial therapy, and consider RMSF as a differential diagnosis in any patient who develops fever and rash in an endemic area.
Subject(s)
Rocky Mountain Spotted Fever , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Chloramphenicol/administration & dosage , Chloramphenicol/therapeutic use , Diagnosis, Differential , Doxycycline/administration & dosage , Doxycycline/therapeutic use , Humans , Male , Rocky Mountain Spotted Fever/diagnosis , Rocky Mountain Spotted Fever/drug therapy , Time Factors , Treatment OutcomeABSTRACT
La fiebre manchada de las Montañas Rocosas (FMMR) es una enfermedad febril aguda causada por Rickettsia rickettsii, caracterizada por un exantema petequial. A pesar de conocer su etiología y manifestaciones clínicas y de disponer de un tratamiento eficaz, su letalidad aún es elevada. En sus estadios iniciales, la FMMR puede aparentar muchas otras enfermedades infecciosas y dificultar su diagnóstico. El presente trabajo informa dos casos con FMMR que ilustran la importancia de su diagnóstico oportuno y tratamiento adecuado, así como de considerar a la FMMR como diagnóstico diferencial ante un paciente febril con exantema que resida en área endémica.
Rocky Mountain spotted fever (RMSF) is an acute febrile illness caused by infection with Ricketsia Rickettsii, characterized by the presence of petechial rash. Even though the etiology, clinical characteristics and availability of effective antibiotics are known, RMSF related deaths have a prevalence of 4%. In its early stages RMFS can resemble many others infectious conditions and the diagnosis can be difficult. The present paper reports two patients with RMSF; these cases underscore the importance of prompt diagnosis and appropriate antimicrobial therapy, and consider RMSF as a differential diagnosis in any patient who develops fever and rash in an endemic area.
Subject(s)
Child , Child, Preschool , Humans , Male , Rocky Mountain Spotted Fever , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Chloramphenicol/administration & dosage , Chloramphenicol/therapeutic use , Diagnosis, Differential , Doxycycline/administration & dosage , Doxycycline/therapeutic use , Rocky Mountain Spotted Fever/diagnosis , Rocky Mountain Spotted Fever/drug therapy , Time Factors , Treatment OutcomeABSTRACT
Introducción. El objetivo del presente estudio es el describir las características epidemiológicas, clínicas y tratamiento recibido por niños con lesiones por mordedura de perro, atendidos en una Unidad de Medicina Familiar. Material y métodos. En forma prospectiva se evaluaron niños menores de 18 años de edad, que sufrieron mordedura de perro, atendidos en una unidad de atención primaria y enviados al Servicio de Medicina Preventiva; siendo evaluados conforme los lineamientos de la Norma Oficial Mexicana para la Prevención y Control de la Rabia. El estudio se realizó en un período de 12 meses, obteniéndose de cada paciente variables demográficas y epidemiológicas relacionadas con el accidente. El tipo de lesión se clasificó de acuerdo con el criterio de Guarnera. La organización y análisis de los datos se presentan utilizando los elementos de la estadística descriptiva, utilizándose la prueba X² para establecer asociación entre las variables categóricas. Resultados. Se incluyeron en el estudio un total de 118 niños, con promedio de edad de 6 años. La mayoría de los accidentes ocurrieron en el hogar (57 por ciento), la participación de perros conocidos del niño se cuantificó en 54 por ciento. Los menores de 5 años presentaron mayor riesgo de agresiones provocadas (60 por ciento) que los niños de mayor edad. Las Lesiones localizadas en la cara y cabeza fueron más frecuentes en los niños pequeños (50 por ciento). La mayoría de las lesiones no fueron graves; 13 se infectaron y casi 50 por ciento de los pacientes requirieron tratamiento antirrábico. Conclusiones. En nuestro medio las mordeduras de perro en la infancia representan un problema de salud frecuente. El tratamiento médico debe incluir un cuidado adecuado de la herida, así como evaluación de vacunación antirrábica. La prevención de las mordeduras de perro requiere de medidas dirigidas a los propietarios de perros, padres, niños y autoridades locales
