RESUMO
Se presenta el caso de un paciente varón de 55 años que ingresó por alteración del estado de conciencia por una hiponatremia severa secundaria a una meningitis tuberculosa. No hubo mejoría de la hiponatremia al tratamiento con solución salina hipertónica, por lo cual se planteó el diagnóstico de síndrome de secreción inapropiada de hormona antidiurética (SIADH) y se evidenció mejoría con la restricción hídrica. El interés del presente caso es reportar una complicación frecuente pero olvidada de la meningitis tuberculosa.
We present the case of a 55-year-old male patient who was admitted due to an altered state of consciousness due to severe hyponatremia secondary to tuberculous meningitis. There was no improvement in hyponatremia after treatment with hypertonic saline solution, therefore the diagnosis of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) was proposed, and improvement was evidenced with fluid restriction. The interest of this case is to report a common but forgotten complication of tuberculous meningitis.
RESUMO
INTRODUCTION: Although 80% of symptomatic individuals with COVID-19 develop mild forms, it is the severe (15%) and critical (5%) forms that have the greatest impact in the hospital setting. Recognizing markers that can predict severe forms is essential, especially in high-altitude populations. METHODS: We conducted a prospective cohort study at 3200 masl (meters above sea level) in a city in Peru to determine if MPV (mean platelet volume) level is a predictor of COVID-19 severity. Patients with mild/moderate disease were enrolled and followed for 21 days or until the development of severe disease (primary outcome). A bivariate analysis was used to identify variables associated with severe disease. A ROC analysis determined the best MPV (mean platelet count) cut-off to predict COVID-19 severity, and then, a multiple regression analysis was performed. RESULTS: 64 patients were enrolled. The median age was 48.5 years (IQT 39-64.5) and the proportion of women was 51.6%, the most frequent symptoms were chest pain (73%), fever (71%), and dyspnea (67%). The median time to develop a severe form from the onset of symptoms was 11 days (IQT 10.5-13). The most common radiographic phase on CT scan (computed tomography) was progressive (60.38%). We observed that an MPV of more than 10.15 fL in the first week of disease predicted severity regardless of age and sex at high altitudes. CONCLUSIONS: MPV in the first week of the disease may predict severity in patients diagnosed with COVID-19 at high altitudes; however, we need prospective studies with a larger population and at a different altitude, levels to confirm these findings.
RESUMO
Introducción: La infección por el virus del dengue es una enfermedad endémica en ciertas regiones del Perú. La mayoría de estos casos se clasifican como dengue sin signos de alarma y la mortalidad reportada es menor de 1%. Sin embargo, existen ciertas condiciones asociadas a la enfermedad que podrían incrementar la mortalidad. Reporte de caso: Se presenta el caso de una paciente mujer de 48 años procedente de área endémica de esta infección con cuadro clínico y hallazgos laboratoriales compatibles con enfermedad por dengue con signos de alarma. Durante la hospitalización, cursa con hemoptisis e insuficiencia respiratoria produciendo su posterior fallecimiento. Conclusión: Es importante reconocer la hemorragia alveolar difusa como parte del compromiso respiratorio por dengue y diferenciarlo de otras posibilidades infecciosas y no infecciosas para poder brindar el manejo adecuado de forma temprana.
Background: Dengue virus infection is an endemic disease in some regions of Peru. Most of these cases are classified as dengue without warning signs and the reported mortality is less than 1%. However, there are certain conditions associated with the disease that could increase mortality. We Case report:present the case of a 48-year-old female patient from a dengue endemic area with clinical and laboratory compatible with dengue disease with warning signs. During hospitalization, she presents hemoptysis and respiratory insufficiency, leading to death. It is important to recognize diffuse alveolar Conclusion:hemorrhage as part of dengue respiratory manifestations and to differentiate it from other infectious and non-infectious possibilities in order to provide appropriate and early management.
RESUMO
RESUMEN La hidatidosis es una infección zoonótica que puede invadir múltiples órganos en el ser humano. Sin embargo, el tejido subcutáneo es el órgano menos afectado por esta enfermedad, cuando esto ocurre se aprecia escasa sintomatología, lo que ocasiona periodos prolongados de enfermedad asociado a diagnóstico tardío y a una pobre respuesta a la terapia antiparasitaria. La sierra central del Perú es la zona con mayor prevalencia, presumiblemente por las inadecuadas medidas de saneamiento ambiental, la falta de educación y las casi inexistentes medidas de control de la enfermedad. Con el objetivo de discutir los problemas relacionados a la localización subcutánea y su probable fisiopatología, reportamos dos casos de hidatidosis subcutánea que se presentaron con lesiones tumorales de evolución prolongada y que no afectaron al hígado ni a los pulmones y que finalmente fueron tratados mediante extirpación quirúrgica debido a la falta de respuesta al tratamiento con albendazol.
ABSTRACT Hydatidosis is a zoonotic infection that can invade many organs in the human being. Nevertheless, the subcutaneous tissue is the less affected organ by this disease. When this disease appears, little symptomatology is observed, which causes prolonged periods of disease associated to delayed diagnosis and a poor answer to the antiparasitic therapy. The central mountain range of Peru is the geographical zone with the greatest prevalence, presumably due to the inadequate measures of environmental sanitation, the lack of education and the almost non-existent control measures of the disease. With the aim to discuss the problems related to the subcutaneous location and its probable physiopathology, this study reports two cases of subcutaneous hydatidosis that appeared with tumor lesions with a prolonged evolution and that did not affect the liver or the lungs and which were finally treated by means of surgical removal due to the lack of response to treatment with albendazol.
Assuntos
Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Tela Subcutânea/parasitologia , Equinococose , Peru , Equinococose/diagnóstico , Equinococose/tratamento farmacológicoRESUMO
Carbapenemases are one of the major mechanisms of antimicrobial resistance, usually due to the indiscriminate use of antibiotics. The expansion of this mechanism of resistance at world level is imminent and control measures are limited. In the region of the Central Sierra of Peru - Huancayo, we report a case of carbapenemase-producing Klebsiella pneumoniae, with the purpose of discussing the problems related to this emerging mechanism of antibiotic resistance.
Las carbapenemasas son uno de los mecanismos enzimáticos de resistencia antimicrobiana, que compromete la mayor parte de los antibióticos betalactámicos. Por lo general, su producción se debe al uso indiscriminado de antimicrobianos. A nivel mundial, la expansión de este mecanismo de resistencia es inminente y las medidas de control son limitadas. Con el objeto de discutir los problemas relacionados a este mecanismo emergente de resistencia, reportamos un caso de Klebsiella pneumoniae productora de carbapenemasas en Huancayo, la Región de la Sierra Central de Perú.
Assuntos
Antibacterianos/farmacologia , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/efeitos dos fármacos , Adulto , Proteínas de Bactérias/metabolismo , Farmacorresistência Bacteriana , Humanos , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/isolamento & purificação , Masculino , Peru , beta-Lactamases/metabolismoRESUMO
Hydatidosis is a zoonotic infection that can invade many organs in the human being. Nevertheless, the subcutaneous tissue is the less affected organ by this disease. When this disease appears, little symptomatology is observed, which causes prolonged periods of disease associated to delayed diagnosis and a poor answer to the antiparasitic therapy. The central mountain range of Peru is the geographical zone with the greatest prevalence, presumably due to the inadequate measures of environmental sanitation, the lack of education and the almost non-existent control measures of the disease. With the aim to discuss the problems related to the subcutaneous location and its probable physiopathology, this study reports two cases of subcutaneous hydatidosis that appeared with tumor lesions with a prolonged evolution and that did not affect the liver or the lungs and which were finally treated by means of surgical removal due to the lack of response to treatment with albendazol.
La hidatidosis es una infección zoonótica que puede invadir múltiples órganos en el ser humano. Sin embargo, el tejido subcutáneo es el órgano menos afectado por esta enfermedad, cuando esto ocurre se aprecia escasa sintomatología, lo que ocasiona periodos prolongados de enfermedad asociado a diagnóstico tardío y a una pobre respuesta a la terapia antiparasitaria. La sierra central del Perú es la zona con mayor prevalencia, presumiblemente por las inadecuadas medidas de saneamiento ambiental, la falta de educación y las casi inexistentes medidas de control de la enfermedad. Con el objetivo de discutir los problemas relacionados a la localización subcutánea y su probable fisiopatología, reportamos dos casos de hidatidosis subcutánea que se presentaron con lesiones tumorales de evolución prolongada y que no afectaron al hígado ni a los pulmones y que finalmente fueron tratados mediante extirpación quirúrgica debido a la falta de respuesta al tratamiento con albendazol.
