ABSTRACT
La fiebre manchada de las Montañas Rocosas es una enfermedad ocasionada por Rickettsia rickettsii, una bacteria transmitida por garrapatas infectadas, y que se caracteriza por fiebre, exantema, artralgias y mialgias, aunque, ocasionalmente, su presentación es inespecífica. Debido a que su evolución asemeja otras enfermedades exantemáticas, como dengue o chikungunya, su diagnóstico no es de primera intención, a pesar de que países como México tienen las características ecológicas y socioeconómicas propicias para su transmisión, con índices de mortalidad hasta de 30% en pacientes pediátricos. Esta elevada mortalidad se asocia a diagnósticos y terapia retrasados debido al desconocimiento médico acerca de la enfermedad, lo que propicia la aparición de formas atípicas y fulminantes de fiebre manchada de las Montañas Rocosas. El objetivo del presente trabajo es describir un caso clínico fulminante de fiebre manchada de las Montañas Rocosas para que sea considerada en el diagnóstico diferencial, lo cual impactaría directamente en los índices de mortalidad.
Rocky Mountain spotted fever is a disease caused by Rickettsia rickettsii, a bacteria transmitted by infected ticks. It is characterized by fever, exanthema, arthralgias and myalgias; but sometimes its clinical presentation is non specific. Due to its similarities with other exanthematic diseases like dengue or chikungunya, Rocky Mountain spotted fever is not a first line diagnosis, even though countries like Mexico show the ecologic and socioeconomic characteristics that favor its transmission, with a 30% mortality rate among pediatric patients. This mortality rate has been associated to a delayed diagnosis and therapy, due to a poor knowledge among physicians regarding this disease; this favors the occurrence of atypical and fulminant cases. The objective of this work is to describe a fulminant case of Rocky Mountain spotted fever, expecting that this disease could be later considered among the differential diagnosis which could directly impact its mortality rate.
Subject(s)
Humans , Female , Infant , Rocky Mountain Spotted Fever/complications , Rocky Mountain Spotted Fever/diagnosis , Fatal Outcome , MexicoABSTRACT
Rocky Mountain spotted fever is a disease caused by Rickettsia rickettsii, a bacteria transmitted by infected ticks. It is characterized by fever, exanthema, arthralgias and myalgias; but sometimes its clinical presentation is non specific. Due to its similarities with other exanthematic diseases like dengue or chikungunya, Rocky Mountain spotted fever is not a first line diagnosis, even though countries like Mexico show the ecologic and socioeconomic characteristics that favor its transmission, with a 30% mortality rate among pediatric patients. This mortality rate has been associated to a delayed diagnosis and therapy, due to a poor knowledge among physicians regarding this disease; this favors the occurrence of atypical and fulminant cases. The objective of this work is to describe a fulminant case of Rocky Mountain spotted fever, expecting that this disease could be later considered among the differential diagnosis which could directly impact its mortality rate.
La fiebre manchada de las Montañas Rocosas es una enfermedad ocasionada por Rickettsia rickettsii, una bacteria transmitida por garrapatas infectadas, y que se caracteriza por fiebre, exantema, artralgias y mialgias, aunque, ocasionalmente, su presentación es inespecífica. Debido a que su evolución asemeja otras enfermedades exantemáticas, como dengue o chikungunya, su diagnóstico no es de primera intención, a pesar de que países como México tienen las características ecológicas y socioeconómicas propicias para su transmisión, con índices de mortalidad hasta de 30% en pacientes pediátricos. Esta elevada mortalidad se asocia a diagnósticos y terapia retrasados debido al desconocimiento médico acerca de la enfermedad, lo que propicia la aparición de formas atípicas y fulminantes de fiebre manchada de las Montañas Rocosas. El objetivo del presente trabajo es describir un caso clínico fulminante de fiebre manchada de las Montañas Rocosas para que sea considerada en el diagnóstico diferencial, lo cual impactaría directamente en los índices de mortalidad
Subject(s)
Rocky Mountain Spotted Fever , Fatal Outcome , Female , Humans , Infant , Mexico , Rocky Mountain Spotted Fever/complications , Rocky Mountain Spotted Fever/diagnosisABSTRACT
BACKGROUND: Respiratory viruses are the main cause of lower respiratory tract infections (LRTI) reported worldwide. The contribution of viral infections to respiratory infections in Mexico has not been fully determined. OBJECTIVE: To determine the contribution of viral infections in hospitalized children with LRTI. METHODS: Children younger than 15 years of age with the admission diagnosis of LRTI were eligible for this study. A nasal wash specimen for virus identification by direct immunofluorescent assay (DFA) was obtained as soon as possible after admission. Clinical and radiographic findings of children with positive and negative detection of viruses were compared. RESULTS: Of 285 subjects admitted to the hospital with LRTI, 265 (93%) had an appropriate specimen for DFA. A viral agent was detected in 125 (47.2%) specimens. Viruses that were identified included respiratory syncytial virus (107), influenza (9) and parainfluenza type 3 (9). Clinical and radiologic diagnoses included bronchiolitis (127), interstitial pneumonia (47) and pneumonia (91). Of the subjects included in the study, 71.3% were younger than 1 year of age. Children with a confirmed viral etiology for their LRTI were younger, had higher respiratory rates on admission and were more likely to present with bronchiolitis than subjects with a negative DFA result. CONCLUSIONS: Respiratory viruses are responsible for at least 47.2% of LRTI requiring hospitalization at our hospital. Respiratory syncytial virus was the most important respiratory agent identified.