Variantes en la presentación clínica de la enfermedad por arañazo de gato en niños del hospital Garrahan / Variants in the clinical presentation of cat scratch disease in children at Garrahan Hospital

La infección por Bartonella henselae (BH) adopta diversas formas de presentación clínica en pediatría. Según la bibliografía la forma de presentación más frecuente en pacientes inmunocompetentes es la linfadenopatía única asociada a fiebre. En el 85 % de los casos se compromete un solo ganglio siendo los axilares y los epitrocleares los más frecuentemente involucrados. Existen otras formas de presentación menos frecuentes que debemos tener en consideración, para poder realizar un diagnóstico precoz e indicar un tratamiento adecuado si así lo requiere. El diagnóstico requiere de la sospecha clínica del equipo de salud tratante, junto al antecedente epidemiológico, los hallazgos clínicos del examen físico y la realización de serologías que incluyan el dosaje de inmunoglobulina M y G. Los objetivos del presente trabajo fueron reconocer las manifestaciones clínicas típicas y atípicas de la EAG por Bartonella henselae, describir la epidemiología, características clínicas y evolución de esta enfermedad que se presentaron en nuestro hospital. Se estudiaron un total de 187 pacientes. La media de edad fue de 7.6 años (rango 1-14); siendo 53.5% de género masculino. Las formas de presentación más frecuentes en nuestro trabajo fueron la adenitis y la fiebre. La mayoría recibió diversos esquemas de tratamiento antibiótico, secundario al retraso en el diagnóstico. La tasa de hospitalización fue muy baja, remitió con tratamiento ambulatorio con antibióticos o sin ellos (AU)

Bartonella henselae infection has different clinical presentations in pediatrics. According to the literature, the most common form of presentation in immunocompetent patients is single lymphadenopathy associated with fever. In 85 % of the cases a single lymph node is involved, with the axillary and epitrochlear nodes being the most commonly involved. There are other, less frequent, forms of presentation that should be taken into consideration in order to make an early diagnosis and indicate appropriate treatment if required. Diagnosis relies on clinical suspicion by the treating healthcare team, together with the epidemiological history, clinical findings on physical examination, and serology including immunoglobulin M and G dosage. The objectives of this study were to identify both the typical and atypical clinical manifestations of Bartonella henselae cat scratch disease, to describe the epidemiology, clinical characteristics, and outcomes of cases presenting at our hospital. A total of 187 patients were studied. The mean age was 7.6 years (range 1-14); 53.5% were male. The most frequent forms of presentation in our study were adenitis and fever. Most of them received different antibiotic treatment regimens due to delayed diagnosis. The hospitalization rate was very low and the disease typically resolved with outpatient treatment, with or without antibiotics (AU)

Multiplex Reverse Transcription Polymerase Chain Reaction Combined with a Microwell Hybridization Assay Screening for Arbovirus and Parasitic Infections in Febrile Patients Living in Endemic Regions of Colombia.

Acute febrile syndrome is a frequent reason for medical consultations in tropical and subtropical countries where the cause could have an infectious origin. Malaria and dengue are the primary etiologies in Colombia. As such, constant epidemiological surveillance and new diagnostic tools are required to identify the causative agents. A descriptive cross-sectional study was conducted to evaluate the circulation and differential diagnosis of six pathogens in two regions of Colombia. The results obtained via multiplex reverse transcription polymerase chain reaction combined with a microwell hybridization assay (m-RT-PCR-ELISA) were comparable to those obtained using rapid tests conducted at the time of patient enrollment. Of 155 patients evaluated, 25 (16.1%) and 16 (10.3%) were positive for malaria and dengue, respectively; no samples were positive for any of the other infectious agents tested. In most cases, m-RT-PCR-ELISA confirmed the results previously obtained through rapid testing.

[Diagnostic protocol for febrile syndrome of respiratory origin in geographical areas of endemic risk of tropical infections]. / Protocolo diagnóstico del síndrome febril con focalidad respiratoria en áreas geográficas de riesgo endémico de infecciones tropicales.

The syndromic surveillance of a group of diseases that have similar signs and symptoms, a common pathophysiology, and diverse etiology is aimed at rapidly detecting the presence of outbreaks which could potentially harm public health. This includes not only known outbreaks of infectious origin but also those of unknown origin. In patients suspected of having SARS-CoV-2/COVID-19, it is recommended to consider other etiologies of tropical fever in the differential diagnosis when these patients live in or come from endemic areas, as is the case of dengue, malaria, leptospirosis, acute Chagas disease, and rickettsiosis, among other endemic diseases. The possibility of SARS-CoV-2/AH1 AH5N1 MERS-CoV coinfection with these pathogens should also be considered.

Valoración de la Escala News (National Early Warning Score) como predictor de sepsis en pacientes con síndrome febril. Servicio Medicina Interna, Hospital Salvador Bienvenido Gautier, agosto-diciembre 2019 / News (National Early Warning Score) scale assessment as sepsis predictor in patients with febril syndrome. Internal Medicine Emergency Department, Salvador Bienvenido Gautier Hospital, August-December 2019

Introducción: la utilización de la escala NEWS podría construir una herramienta en el diagnóstico, pronóstico y estratificación precoz ante la sospecha de sepsis. El propósito de esta investigación fue determinar la eficacia de la escala NEWS como predictor de sepsis en pacientes ingresados por síndrome febril en el Hospital Salvador Bienvenido Gautier, en el período de octubre-diciembre 2019. Material y método: se realizó un estudio descriptivo, prospectivo y de corte transversal donde la técnica utilizada para la recolección de la información fue la evaluación directa de los 43 pacientes admitidos aplicando la escala NEWS y revisión de expedientes clínicos. Resultados: se determinó que el punto de corte ≥6 en la escala NEWS obtuvo valores de sensibilidad (91 %), especificidad (70 %), índice de Youden de 0.61, valor predictivo positivo de 78 %, valor predictivo negativo de 88 %, razón de verosimilitud positiva de 3 y negativa de 0.1. La aplicación de la escala NEWS en el sexo masculino presentó una sensibilidad de 92.9 % y especificidad de 87.5 %. En los grupos de 18-30 y 71-80 años, esta escala presentó una sensibilidad y especificidad de 100 %. Los pacientes clasificados como riesgo bajo, moderado y alto fueron diagnosticados con sepsis el 16.67 %, 63.64 % y un 70 %, respectivamente. Conclusiones: una puntuación mayor o igual a 6 en la escala NEWS se presenta como un predictor estadísticamente significativo que ayudaría en el diagnóstico temprano de sepsis, siendo más sensible que especifica. Fue mejor predictor en el sexo masculino y en los grupos etarios de 18-30 y 71-80 años

Introduction: The use of the NEWS could build a tool in the diagnosis, prognosis and early stratification in case of suspected sepsis. The purpose of this research was to determine the efficacy of the NEWS as a predictor of sepsis in patients admitted for febrile syndrome at the Salvador Bienvenido Gautier Hospital, October-December 2019. Materials and methods: A descriptive, prospective and crosssectional study was conducted where the technique used for the collection of the information was the direct evaluation of the 43 admitted patients applying the NEWS and the review of clinical records. Results: It was determined that the cutoff point ≥6 on the NEWS obtained sensitivity value (91%), specificity (70%), Youden index of 0.61, positive predictive value of 78%, negative predictive value of 88%, ratio of positive likelihood of 3 and negative of 0.1. The application of the NEWS scale in males presented a sensitivity of 92.9% and specificity of 87.5%. In the groups of 18-30 and 71-80 years, this scale presented a sensitivity and specificity of 100%. Patients classified as low, moderate and high risk were diagnosed with sepsis 16.67%, 63.64% and 70% respectively. Conclusions: A score greater than or equal to 6 on the NEWS is presented as a statistically significant predictor that would help in the early diagnosis of sepsis being more sensitive than specific. It was a better predictor in the male sex and in the age groups of 18-30 and 71-80 years

Is prolonged febrile syndrome associated with reactive thrombocytosis a possible association in the diagnosis of Takayasu's arteritis? A case report.

Takayasu's arteritis is a rare, systemic, inflammatory vasculitis of large blood vessels with an unknown aetiology that more frequently affects women of childbearing age with progression to stenosis, fibrosis or thrombogenesis. Clinical manifestations are associated either with inflammation of the vascular wall (including fever, myalgia, arthralgia, weight loss) or the development of aneurysms and extensive vascular lesions, which creates challenges for a differential diagnosis. This current report presents the case of a female Caucasian patient, aged 23 years, that presented herself repetitively at the hospital reporting symptoms including fever, productive cough, myalgia associated with physical effort, arthralgia, inconstant headache, weight loss and altered general condition. The patient was diagnosed with Takayasu's arteritis in the context of a prolonged febrile syndrome associated with reactive thrombocytosis. This association results in the need to exclude multiple differential diagnoses. Nonspecific management was initiated, which included antibiotic treatment, antifungal medication, anticoagulants, steroidal anti-inflammatory drugs and correction of anaemia. The patient slowly improved. Takayasu's arteritis in the inflammatory phase associated with a prolonged febrile syndrome and reactive thrombocytosis is a rare diagnosis of exclusion of a multitude of inflammatory diseases of large blood vessels, infectious diseases and neurofibromatosis, which requires multiple investigations for an accurate diagnosis and management.

Características epidemiológicas del síndrome febril inespecífico en Nueva Paz, Mayabeque / Epidemiological Characteristics of Nonspecific Febrile Syndrome in Nueva Paz Municipality, Mayabeque Province

Introducción: La vigilancia del síndrome febril inespecífico es una estrategia para la identificación temprana de enfermedades de interés en salud pública y de otras enfermedades no diagnosticadas usualmente. Objetivo: Determinar las características epidemiológicas del síndrome febril inespecífico. Métodos: Estudio descriptivo-transversal en pacientes con diagnóstico inicial de síndrome febril inespecífico en el municipio Nueva Paz, Mayabeque, en el período enero-diciembre, 2018. El universo estuvo constituido por 828 casos. Los datos obtenidos de la Unidad Municipal de Higiene y la base de datos de arbovirosis se vaciaron en una planilla creada al efecto. Las variables cuantitativas se resumieron mediante media aritmética y desviación estándar y las variables cualitativas mediante porcentajes. La comparación de proporciones se realizó a través de chi-cuadrado y dócima de Duncan, con un nivel de significación para p < 0,05. Resultados: Predominó el sexo femenino (55,08 por ciento) y la edad menor de 18 años (33,93 por ciento). Se encontró mayor número de focos en el área de salud de Los Palos (53,44 por ciento), donde se reportó más cantidad de síndrome febril inespecífico (50,60 por ciento). Los meses de mayo, julio y octubre notificaron mayor número de focos. La vigilancia se comportó en 61,7 por ciento con una reactividad en 56,50 por ciento. El 48,06 por ciento de los casos clasificaron dengue. Conclusiones: El incumplimiento de los programas de control del vector, la urbanización no planificada, el crecimiento acelerado de la población y la existencia de una infraestructura de salud deficiente ha permitido que proliferen las arbovirosis a gran escala en el municipio Nueva Paz(AU)

Introduction: Surveillance of nonspecific febrile syndrome is a strategy for early identification of public health concern diseases as well as other diseases not usually diagnosed. Objective: To determine the epidemiological characteristics of nonspecific febrile syndrome. Methods: Descriptive and cross-sectional study carried put, in the period January-December 2018, in patients with an initial diagnosis of nonspecific febrile syndrome from Nueva Paz Municipality, Mayabeque Province. The universe consisted of 828 cases. The data obtained from the Municipal Unit of Hygiene and Epidemiology as well as from the arbovirus diseases database were emptied into a form created for this purpose. Quantitative variables were summarized using arithmetic mean and standard deviation, while qualitative variables were summarized using percentages. The comparison of proportions was made through chi-square and Duncan's tests, with a level of significance P<0.05. Results: There was a predominance of the female sex (55.08 percent) and ages under eighteen years (33.93 percent). A greater number of focuses were found in the health area of Los Palos (53.44 percent), where a greater amount of nonspecific febrile syndrome was reported (50.60 percent). The months of May, July and October accounted for higher numbers of outbreaks. Surveillance was 61.7 percent with reactivity at 56.50 percent, 48.06 percent of the cases classified as dengue. Conclusions: Failure to comply with vector control programs, unplanned urban planning, accelerated population growth and the existence of a deficient health infrastructure have allowed great-scale arbovirus infections to proliferate in Nueva Paz Municipality(AU)

Larva migrans visceral como causa de síndrome febril prolongado y eosinofilia severa. Reporte de un caso

RESUMEN Toxocara canis y catis son helmintos que parasitan el intestino del perro o del gato, sus huéspedes definitivos. Las hembras eliminan huevos infectantes al medio ambiente, que, ingeridos accidentalmente por el ser humano, sólo desarrollan el estado larvario en etapa embrionaria y causan la toxocariasis. Esta es una zoonosis extendida por todo el mundo, especialmente en aquellas áreas donde prevalecen condiciones deficientes de hábitat e higiene. El cuadro clínico puede variar desde formas asintomáticas a la larva migrans visceral (LMV) o larva migrans ocular (LMO), debidas a la diseminación de larvas embrionadas en el hígado, pulmones y en menor medida el SNC. La LMV se caracteriza clínicamente por la presencia de hepatomegalia, infiltración pulmonar con tos, eosinofilia de variada intensidad, hiper Ig E y anticuerpos Ig G anti-toxocara. Por no ser la fiebre un síntoma clínico destacado, se presenta el siguiente caso clínico.

ABSTRACT Toxocara canis and catis are helminths that parasitize the intestine of dogs or cats, their definitive hosts. Females shed infective eggs into the environment, which, when accidentally ingested by humans, only develop the embryonic larval stage and cause toxocariasis. This is a zoonosis that is widespread throughout the world, especially in those areas where poor habitat and hygienic conditions prevail. The clinical picture can vary from asymptomatic forms to visceral larva migrans (VLM) or ocular larva migrans (OLM), due to the dissemination of embryonic larvae in the liver, lungs and to a lesser extent the CNS. VLM is clinically characterized by the presence ofhepatomegaly, pulmonary infiltration with cough, eosinophilia of varying intensity, hyper Ig E and Ig G anti-toxocara antibodies. Since fever is not a prominent clinical symptom, the following clinical case is presented.

Reto Diagnóstico: Hipoacusia, Enteropatía Autoinmune y Linfadenopatia de Kikuchi ­ un Debut Inusual de LES / Diagnostic challenge: hearing loss, autoimmune enteropathy and Kikuchi lymphadenopathy - An unusual debut of SLE

El lupus eritematoso sistémico (LES) puede presentarse de muchas maneras y puede ser difícil de diagnosticar. En ocasiones puede ser difícil distinguir la enfermedad subyacente, ya que se sabe que el LES mismo causa síntomas gastrointestinales e incluso malabsorción. Este caso refleja los desafíos de diagnóstico que enfrentamos durante la larga y complicada hospitalización de una adolescente con compromiso sistémico, síndrome febril, malabsorción, marcadores inflamatorios elevados, hipoacusia, nefritis, linfadenitis necrotizante histiocítica

Systemic lupus erythematosus (SLE) can present in many ways and can be difficult to diagnose. It can sometimes be difficult to distinguish the underlying disease, as SLE itself is known to cause gastrointestinal symptoms and even malabsorption. This case reflects the diagnostic challenges we faced during the long and complicated hospitalization of an adolescent with systemic compromise, febrile syndrome, malabsorption, elevated inflammatory markers, hearing loss, nephritis, histiocytic necrotizing lymphadenitis

Facial diplegia as a manifestation of neuroleptospirosis / Diplejía facial como manifestación de neuroleptospirosis

Abstract This case series describes the clinical and paraclinical findings in two young men with bilateral peripheral facial palsy or facial diplegia during the convalescent period of leptospirosis, who recovered neurologically without sequelae. This highlights the role of spirochetes in the development of an atypical and rare variant of Guillain-Barré syndrome. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.1947).

Resumen Esta serie de caso describe los hallazgos clínicos y paraclínicos observados en dos hombres jóvenes, con parálisis facial periférica bilateral o diplejía facial durante la fase de convalecencia de la leptospirosis, con recuperación neurológica sin secuela; resaltando así, el papel de la espiroqueta en el desarrollo de una variante atípica y poco frecuente del síndrome de Guillain-Barré. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.1947).

Infectious Pyomyositis With Intramuscular Abscess in a Healthy Adult.

Pyomyositis is an uncommon bacterial infection of the skeletal muscle, with most cases presenting with an intramuscular abscess. Although it is more frequent in tropical regions, it can also occur in temperate regions, essentially in adult males with comorbidities. We report a case of an adult male with an intramuscular abscess and demonstrate the importance of meticulous clinical examination and imaging examinations in obtaining a diagnosis for pathologies with nonspecific clinical manifestations.

Human Rickettsiosis Caused by Rickettsia parkeri Strain Atlantic Rainforest, Urabá, Colombia.

We describe the clinical, serologic, and molecular findings of a new human rickettsiosis in Colombia. Antibodies against Rickettsia spp. were detected. PCR showed amplification of genes for R. parkeri strain Atlantic Rainforest. This new rickettsiosis of minor virulence could explain some of the undifferentiated acute febrile diseases in Colombia.

Host-Based Prognostic Biomarkers to Improve Risk Stratification and Outcome of Febrile Children in Low- and Middle-Income Countries.

Fever is one of the leading causes for pediatric medical consultation and the most common symptom at clinical presentation in low- and middle-income countries (LMICs). Most febrile episodes are due to self-limited infections, but a small proportion of children will develop life-threatening infections. The early recognition of children who have or are progressing to a critical illness among all febrile cases is challenging, and there are currently no objective and quantitative tools to do so. This results in increased morbidity and mortality among children with impending life-threatening infections, whilst contributing to the unnecessary prescription of antibiotics, overwhelming health care facilities, and harm to patients receiving avoidable antimicrobial treatment. Specific fever origin is difficult to ascertain and co-infections in LMICs are common. However, many severe infections share common pathways of host injury irrespective of etiology, including immune and endothelial activation that contribute to the pathobiology of sepsis (i.e., pathogen "agnostic" mechanisms of disease). Importantly, mediators of these pathways are independent markers of disease severity and outcome. We propose that measuring circulating levels of these factors can provide quantitative and objective evidence to: enable early recognition of severe infection; guide patient triage and management; enhance post-discharge risk stratification and follow up; and mitigate potential gender bias in clinical decisions. Here, we review the clinical and biological evidence supporting the clinical utility of host immune and endothelial activation biomarkers as components of novel rapid triage tests, and discuss the challenges and needs for developing and implementing such tools.

Neuroleptospirosis con pericarditis y colestasis intrahepática (Síndrome de Weil) / Neuroleptospirosis with Pericarditis and Intrahepatic Cholestasis (Weil syndrome)

Introducción: El síndrome de Weil es una forma grave de la infección bacteriana causada por la bacteria Leptospira, conocida como leptospirosis. Este se caracteriza por la disfunción de múltiples órganos, entre ellos, hígado, riñón, músculos, serosas o el sistema neurológico, en este caso denominado neuroleptospirosis, genera una mortalidad muy elevada cuando no se brinda diagnóstico y tratamiento adecuado. Objetivo: Describir las manifestaciones clínicas, paraclínicos complementarios y tratamiento de un paciente con síndrome de Weil, una condición poco frecuente. Caso clínico: Paciente de 23 años quien consulta en el contexto de síndrome febril agudo asociado con neuritis óptica, dolor torácico y paraclínicos que evidenciaron afectación hepática y cardíaca. Se confirma el diagnóstico de síndrome de Weil dado por neuroleptospirosis, pericarditis y colestasis intrahepática. Conclusiones: mediante un caso clínico de síndrome de Weil, se describe la afectación multisistémica de complicaciones asociadas con leptospirosis, con manifestaciones poco habituales como neuroleptospirosis, pericarditis y colestasis intrahepática(AU)

Introduction: Weil syndrome is a serious form of the bacterial infection caused by the Leptospira bacterium; this is known as leptospirosis. This is characterized by multiple organ dysfunction; for example, the liver, kidney, muscles, of serous type, or the neurological system, in this case called neuroleptospirosis, which produces a very high mortality when adequate diagnosis and treatment are not provided. Objective: To describe the clinical manifestations, complementary paraclinic practice and treatment of a patient with Weil syndrome, as a rare condition. Clinical case: 23-year-old patient who presents with acute febrile syndrome associated with optic neuritis, chest pain, and paraclinical symptoms obviously consistent liver and cardiac involvement. The diagnosis of Weil syndrome is confirmed, specifically defined by neuroleptospirosis, pericarditis, and intrahepatic cholestasis. Conclusions: Through a clinical case of Weil syndrome, the multisystem involvement of complications associated with leptospirosis is described, along with its unusual manifestations, such as neuroleptospirosis, pericarditis, and intrahepatic cholestasis(AU)

Tuberculosis peritoneal. Caso clínico diagnosticado por laparoscopia / Peritoneal tuberculosis. Use of laparoscopy in the diagnosis

RESUMEN Se presenta el caso de un paciente diabético de 55 años de edad internado en la sala de Medicina Interna del Hospital Pablo Arturo Suárez de Quito - Ecuador, que acude con un síndrome febril de 8 días de evolución que se prolongó durante la hospitalización a más de 35 días sin causa o foco aparente, a pesar del tratamiento antipirético, acompañado de dolor abdominal difuso, pérdida de peso (aproximadamente 8 kg en 3 meses) y ascitis. Se investigó las posibles etiologías, incluyendo pruebas de alta sensibilidad y especificidad para tuberculosis como (Cuantiferon GOLD Tb), adenosina deaminasa (ADA), que resultó falsa-negativa. El diagnóstico se confirmó mediante biopsia peritoneal de una muestra obtenida por laparoscopia exploratoria como último recurso diagnóstico. La tuberculosis peritoneal es una enfermedad que ocurre por la reactivación de los focos tuberculosos latentes en el peritoneo, debido a la diseminación hematógena, linfática o por contigüidad a un foco primario; más del 90% de los pacientes tienen ascitis en el momento de la presentación y un 10% presenta una fase "seca" más avanzada con un abdomen "pastoso" (es una forma de enfermedad fibroadhesiva).Palabras claves: tuberculosis peritoneal, ascitis, síndrome febril prolongado, biopsia peritoneal, falsos negativos en pruebas diagnósticas de tuberculosis

ABSTRACT The case of a diabetic patient of 55 years of age is presented in the internal medical room of Pablo Arturo Suarez Hospital of Quito - Ecuador, the same comes with a febril syndrome of 8 days of evolution that prolonged during the hospitalization to more of 35 days without cause or apparent focus despite the antipyretic treatment, accompanied by diffuse abdominal pain, weight loss and ascitis, where the possible etiologies were investigated, including tests of high sensitivity and specificity for tuberculosis as (quantiferon), resulting false negative, confirming the diagnosis through peritoneal biopsy of a sample obtained by exploratory laparoscopy as a last diagnostic resource. Peritoneal tuberculosis is a disease that occurs by the reactivation of latent tuberculosous focus in the peritoneum, established by hematogen, lymphatic or contiguous dissemination of a primary focus, where more than 90% of patients have ascitis at the time of presentation, and a 10% present a more advanced "dry" phase with a "pastoso" abdomen, representing a form of fibroadhesive disease.Keywords:peritoneal tuberculosis, ascites, prolonged febrile syndrome peritoneal biopsy, false negatives in diagnostic tests for tuberculosis.

Clinical relevance of Zika symptoms in the context of a Zika Dengue epidemic.

BACKGROUND: The clinical characteristics of the most frequent arbovirosis (Dengue, Zika, Chikungunya) are very similar, which is a diagnostic challenge for clinicians. OBJECTIVE: To identify the presence of clinical characteristics related to Zika virus infection confirmed by the laboratory in patients during an epidemic of co-infection with Zika and Dengue viruses. METHOD: Cross-sectional descriptive study of patients with clinical - epidemiological suspicion of Zika virus infection, who were admitted in the Hospital "Joaquín Albarrán" (La Habana, Cuba), during June 1 to October 31 of 2017. Demographic and symptoms and signs were recorded. By PCR for Zika virus (in blood or urine) the disease was confirmed. RESULTS: 1541 patients were studied. The most frequent symptoms and signs were rash (93.8%), pruritus (77.9%), arthralgia (60.0%), headache (50.8%), myalgia (46.1%), fever (34.7%), asthenia (31.7%), and conjunctivitis (27.9%). Zika virus infection was confirmed in 279 patients (18.1%). Greater frequency of arthralgia, asthenia, and diarrhea was demonstrated in Zika confirmed patients. CONCLUSION: Minor clinical relevance was observed in the symptoms or signs of arboviral disease to support the clinical diagnosis of Zika virus infections by clinician during a Zika-Dengue epidemic. The assessment of the temporality of the onset of Zika and Dengue symptoms of these infections is recommended to assist clinicians in the differential diagnosis.

Brotes emergentes de leptospirosis del Amazonas colombiano / Emerging leptospirosis outbreaks in the Colombian Department of Amazonas

Se describe por primera vez una serie de nueve casos con clínica indicativa de leptospirosis en el municipio Puerto Nariño en el departamento Amazonas, Colombia. Se muestran evidencias serológicas de exposición con Rickettsia del grupo de las fiebres manchadas. Los casos fueron clínicamente considerados como síndrome febril de origen desconocido. Se descartó infección por dengue y malaria. El diagnóstico de Leptospira se realizó mediante el método de reacción en cadena de la polimerasa en tiempo real. Igualmente, se detectó la presencia de anticuerpos contra rickettsias del grupo de las fiebres manchadas por inmunofluorescencia Indirecta. Finalmente, se realiza revisión del tema(AU)

A description is provided for the first time of a series of nine cases with a clinical examination suggestive of leptospirosis in the municipality of Puerto Nariño, Department of Amazonas, Colombia. Serological evidence is presented of exposure to Rickettsia, spotted fever group. The cases were clinically considered as febrile syndrome of unknown origin. Infection with dengue or malaria was ruled out. Diagnosis of leptospirosis was achieved by real-time polymerase chain reaction. Additionally, indirect immunofluorescence detected the presence of antibodies against rickettsia, spotted fever group. Finally, a review was conducted about the topic(AU)

Human parvovirus B19 genotype 1 in suspected dengue patients of Tefé, Amazonas State, Brazil

Abstract INTRODUCTION: Human parvovirus B19 (B19V) is a common pathogen, which on infection causes variety of clinical conditions from benign self-limiting exanthematous disease and other similar pathologies to fetal death. METHODS: We collected 341 serum samples between the first and fourth day after the onset of symptoms from all patients suspected of dengue fever who were attended at Regional Hospital of Tefé. Initially, patients were screened for malaria by blood smear test and negative samples were sent to Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD) situated in Manaus (AM) for dengue testing using semi-nested multiplex PCR. Further, we investigated 44 malaria and dengue-negative samples of children for B19V DNA by nested-PCR. Positive samples were analyzed by BLAST against entire public non-redundant nucleotide database and genotyped by phylogenetic analyses using neighbor-joining clustering method. RESULTS: Eight samples (18.2%) were found to be PCR positive. Fever, headache, ocular pain, and/or muscle pain were reported as the most frequent symptoms by the patients and none were diagnosed with rash at the time of sample collection. Phylogenetic analysis of major capsid protein 2 (VP2) and VP3 coding region showed high similarity with B19V genotype 1. CONCLUSIONS: Our results reveal the spread of B19V genotype 1 in Tefé. Moreover, our results emphasize the significance of laboratorial differential diagnosis using molecular techniques in patients with acute febrile, and thereby aid the health surveillance system in improving patient care even in the remote areas of Amazon.

Comportamiento de la vigilancia de síndrome febril inespecífico / Behavior of the surveillance of the unspecific febrile syndrome

Introducción: La vigilancia del síndrome febril inespecífico es objeto de especial atención, frecuente expresión de la ocurrencia de enfermedades emergentes y reemergentes; su detección oportuna permite formular medidas de intervención adecuadas. Objetivo: Evaluar el comportamiento de la vigilancia del síndrome febril inespecífico. Métodos: Se realizó una investigación observacional descriptiva de corte transversal, mediante la vigilancia activa y pasiva. La población objeto de estudio se determinó por los 384 pacientes detectados con síndrome febril inespecífico en las tres áreas de salud: Juan M. Páez Inchausti, Leonilda Tamayo Matos y Oreste Falls Oñate en la Isla de la Juventud, durante el período de enero a junio de 2017. Se utilizó como fuente primaria de datos la encuesta epidemiológica de cada caso. Para el análisis se emplearon frecuencias absolutas, relativas y tasas. Se evaluaron dos atributos del sistema (oportunidad y valor predictivo positivo). Resultados: La mayor notificación se produjo en las últimas semanas estadísticas, con predominio del área de salud Juan M. Páez Inchausti, que mostró una tasa de 61,8 x 104 hab. Al sexo masculino se atribuyeron 207 casos (48,6 x 10 4 hab.) y la mayor incidencia se evidenció en los menores de 1 año con 48 casos (497,9 x 104 hab). La frecuencia de síntomas presentó el 95,8 por ciento (368) para la fiebre, seguido de la cefalea 47,1 por ciento (181). El atributo de oportunidad se evaluó de medianamente suficiente y el valor predictivo positivo se consideró bajo. Conclusiones: La vigilancia mostró su mayor efectividad en las últimas semanas. Según características demográficas predominó el sexo masculino y la mayor incidencia fue en los menores de 1 año. Existen algunas insuficiencias en el cumplimiento de los atributos esenciales, sin embargo, no afecta el resultado del sistema en su conjunto(AU)

Introduction: The surveillance of the unspecific febrile syndrome is a subject of special attention because it is the most common expression of the occurrence of emerging and re-emerging diseases. Its timely detection allows the formulation of adequate intervention measures. Objective: To evaluate the behavior of the surveillance of the unspecific febrile syndrome. Methods: A descriptive, cross-sectional, observational investigation was carried out through active and passive surveillance. The population studied was determined by 384 patients detected having unspecific febrile syndrome, in three health areas: Juan M. Páez Inchausti, Leonilda Tamayo Matos y Orestes Falls Oñate, located in Isla de la Juventud special municipality , from January to June 2017 . The epidemiological survey of each case was used as the primary source of data. For the analysis, absolute frequencies, relative frequencies and rates were used. Two attributes of the system were evaluated (opportunity and positive predictive value). Results: The highest notification occurred in the last weeks being predominant Juan M. Páez Inchausti health area, which showed the highest rate (61.8 x 104 inhab.). 207 cases were of the male sex (48.6 x 10 4 inhab.) and the highest incidence was evidenced in those younger than 1 year, with 48 cases (497.9 x 104 inhab). The frequency of symptoms was of 95.8 percent (368) for fever, followed by headache 47.1 percent (181). The opportunity attribute was evaluated as medium enough and the PPV was low. Conclusions: The surveillance showed its greatest effectiveness in the last weeks. According to the socio-demographic characteristics, the male sex predominated and the incidence was greater in the ages from 1 to 4 years old. There are some deficiencies in the fulfillment of the essential attributes; however, it does not affect the result of the system as a whole(AU)

67-Gallium SPECT/CT in febrile syndromes of unknown origin. / SPECT/TC con galio-67 en los síndromes febriles sin foco conocido.

INTRODUCTION AND OBJECTIVE: Febrile syndromes of unknown origin (FSUO) are complex processes in hospital practice. Their management includes an exhaustive medical history and examination, as well as an extensive number of biochemical tests. If these are inconclusive, diagnostic imaging techniques such as SPECT/CT with 67-Gallium Citrate (67Ga-SPECT/CT) could play an important role. We evaluated its role in the management of FSUO in our healthcare area. MATERIAL AND METHODS: We reviewed 57 patients who underwent a 67Ga-SPECT/CT due to a FSUO (32 women and 25 men, age range: 32-83 years old) obtaining scintigraphic findings, previous treatments and final diagnosis. Values of sensitivity, specificity, positive predictive values (VPP) and negative values (NPV) were obtained and compared with the results for PET/CT with 18Fluor-deoxy-glucose (18F-FDG PET/CT) found in the literature. RESULTS: The diagnoses found were: infection in 27/57 (47%), inflammatory disease in 15/57 (26%), neoplasm in 1/57 (1.75%) and patients without final diagnosis in 14/57 (24%). The statistical values of 67Ga-SPECT/CT were: sensitivity, specificity, PPV and NPV of 67%, 93%, 97% y 48%, respectively which were slightly lower than those found for the 18F-FDG PET/CT (86%, 52%, 70% and 92%, respectively). The diagnostic yield was 73% which increased to 80% in the patients who lacked empirical treatment. CONCLUSION: Despite the better results of 18F-FDG PET/CT, 67Ga-SPECT/CT behaved as a useful technique in the management of FSUO. It is advisable to use it if 18F-FDG PET/CT is not available.