RESUMO
The febrile patient from tropical areas, in which emerging arboviruses are endemic, represents a diagnostic challenge, and potential co-infections with other pathogens (i.e., bacteria or parasites) are usually overlooked. We present a case of an elderly woman diagnosed with dengue, chikungunya and Leptospira interrogans co-infection. Study Design: Case report. An 87-year old woman from Colombia complained of upper abdominal pain, arthralgia, myalgia, hyporexia, malaise and intermittent fever accompanied with progressive jaundice. She had a medical history of chronic heart failure (Stage C, New York Heart Association, NYHA III), without documented cardiac murmurs, right bundle branch block, non-valvular atrial fibrillation, hypertension, and chronic venous disease. Her cardiac and pulmonary status quickly deteriorated after 24 h of her admission without electrocardiographic changes and she required ventilatory and vasopressor support. In the next hours the patient evolved to pulseless electrical activity and then she died. Dengue immunoglobulin M (IgM), non-structural protein 1 (NS1) enzyme-linked immunosorbent assay (ELISA), microagglutination test (MAT) for Leptospira interrogans and reverse transcription polymerase chain reaction (RT-PCR) for chikungunya, were positive. This case illustrates a multiple co-infection in a febrile patient from a tropical area of Latin America that evolved to death.
RESUMO
Introducción: La tuberculosis (TB) es la primera causa de morbi-mortalidad en población privada de la libertad, su incidencia oscila entre los 25 a 7000 casos por cada 100 000 personas privadas de la libertad por año en comparación a 25,6 por cada 100 000 habitantes en la población general a nivel mundial. Objetivo: Determinar la prevalencia de tuberculosis pulmonar en población privada de la libertad sintomática respiratoria del departamento del Tolima para el año 2013. Materiales y métodos: Estudio de corte transversal en población privada de la libertad recluida en centros penitenciarios de 10 ciudades de Colombia; se realizó búsqueda activa de personas privadas de la libertad con tos y expectoración; a estos se les tomaron muestras de esputo expectorado y/o saliva, muestras oro-faringeas y se les realizó tinción de Ziehl-Neelsen para bacilos ácido-alcohol resistente (BAAR) y cultivo de Ogawa Kudoh para Mycobacterium tuberculosis. Resultados: Del total de población privada de la libertad el 16,2% (1129/6961) eran sintomáticos respiratorios, la edad media fue de 27 años (rango 24 a 45), 53% (n=601) tuvo tos menos de 15 días, 24% presentó fiebre y 23,6% que presentó sudoración nocturna. La prevalencia de tuberculosis fue del 1,5% (n=17 personas privadas de la libertad) con una tasa de incidencia de 244,22 por cada 100 000 personas privadas de la libertad y una tasa ajustada de incidencia 293,15 por cada 100 000 personas privadas de la libertad para Ibagué. Conclusiones: Este estudio muestra la alta prevalencia de TB en población privada de la libertad del Tolima y resalta la importancia de definir protocolos de tamizaje más rigurosos para la población privada de la libertad que para los de la población general.
Introduction: Tuberculosis (TB) is the leading cause of morbidity and mortality in prisoners, its annual incidence is 25 to 7000 cases per 100,000 prisoners vs. 25.6 per 100,000 in the worldwide general population. Objective: To determine the prevalence of tuberculosis in prisoners with respiratory symptoms in Tolima-Colombia during 2013. Material and methods: Cross-sectional study performed in inmates from prisons in 10 Colombian cities. Active surveillance of inmates with respiratory symptoms (cough and sputum production) was performed; sputum, saliva, and/or oro-pharyngeal samples were obtained, and Ziehl-Neelsen staining for direct examination and Ogawa-Kudoh Mycobacterium tuberculosis cultures were performed. Results: The prevalence of respiratory symptoms was 16.2% (1129/6961), the mean age of these subjects was 27 years (range 24 to 45), 53% (601) had cough for <15 days, 24% had fever and 23.6% had night sweats. The prevalence of tuberculosis was 1.5% (17/1129), the incidence rate for these inmates was 244.22 per 100,000 and the adjusted prevalence rate was 293.15 per 100,000 prisoners in Ibague. Conclusions: This study shows the high prevalence of TB in prisoners of Tolima and highlights the importance of defining more strict TB screening protocols for inmates compared with those for the general population
