RESUMO
BACKGROUND: Rocky Mountain spotted fever (RMSF) is an increasingly important cause of preventable mortality in children in Sonora, Mexico. Although early treatment with tetracycline has shown to prevent fatal outcome, the disease remains a life-threatening condition, particularly for children. This study describes the clinical factors associated with pediatric mortality due to RMSF in Sonora, in order to guide healthcare practices. METHODS: This is a retrospective analysis of 104 children consecutively hospitalized at the major pediatric hospital of Sonora, diagnosed with RMSF between January 2004 and December 2013. Descriptive statistics and multiple logistic regression were used to identify risk factors for fatal outcome. RESULTS: The case fatality ratio in this cohort was 20.2%. Children were hospitalized after a median of 6 days from onset of symptoms including fever (100%), rash involving palms and soles (88.5%) and headache (79.8%); 90.4% of fatal cases had low platelet counts (<50,000/µL) and 33.3% showed serum creatinine concentrations above the normal value. Acute kidney injury increased mortality, odds ratio (OR(adj)) = 4.84, 95% confidence interval (CI): 1.2-16.2, as well as delay in treatment (≥ 5th day from onset) with doxycycline, OR(adj) = 2.62, 95% CI: 1.24-5.52 and hemorrhage, OR(adj) = 6.11, 95% CI: 1.89-19.69. CONCLUSIONS: RMSF is a public health problem in Sonora. Clinically, fatal cases differ from non-fatal cases in renal function and hemorrhagic manifestations, although these findings may occur too late for a timely intervention. First-line providers must be educated to harbor a timely suspicion of RMSF, and should provide empiric treatment with doxycycline when febrile patients first present for care.
Assuntos
Insuficiência Renal/mortalidade , Insuficiência Renal/patologia , Febre Maculosa das Montanhas Rochosas/mortalidade , Febre Maculosa das Montanhas Rochosas/patologia , Adolescente , Animais , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Doxiciclina/uso terapêutico , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , México , Mortalidade , Prognóstico , Insuficiência Renal/tratamento farmacológico , Estudos Retrospectivos , Fatores de Risco , Febre Maculosa das Montanhas Rochosas/complicações , Febre Maculosa das Montanhas Rochosas/tratamento farmacológico , Adulto JovemRESUMO
A serosurvey for human ehrlichiosis caused by Ehrlichia chaffeensis and Anaplasma phagocytophilum was performed in different regions of Peru by using indirect immunofluorescence assays (IFAs). Regions included an urban community in a shantytown in Lima (Pampas) and three rural communities located on the northern coast of Peru (Cura Mori), in the southern Peruvian Andes (Cochapata), and in the Peruvian jungle region (Santo Tomas). An overall E. chaffeensis seroprevalence of 13% (21 of 160) was found by IFA. Seroprevalences in females and males was 15% (16 of 106) and 9% (5 of 53), respectively. Seroprevalences in Cura Mori, Cochapata, Pampas, and Santo Tomas were 25% (10 of 40), 23% (9 of 40), 3% (1 of 40), and 3% (1 of 40), respectively. Seroprevalences in Cura Mori and Cochapata were significantly higher than in Santo Tomas or Pampas (P < 0.01). No sera were reactive to A. phagocytophilum. These findings suggest that human infection with E. chaffeensis occurs in Peru. Further studies are needed to characterize Ehrlichia species in Peru, their vectors and their clinical significance.
Assuntos
Anaplasma phagocytophilum/imunologia , Anticorpos Antibacterianos/sangue , Ehrlichia chaffeensis/imunologia , Ehrlichiose/epidemiologia , Ehrlichiose/imunologia , Ehrlichiose/microbiologia , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Masculino , Peru/epidemiologia , População Rural , Estudos Soroepidemiológicos , População UrbanaRESUMO
Blood samples from dogs with clinical signs compatible with ehrlichiosis were examined for infection of Ehrlichia canis using PCR, multiplex real-time PCR, and DNA sequencing analysis. Eleven of 25 samples were positive for a new strain of E. canis. This is the first molecular identification of E. canis infection in dogs from Peru.
Assuntos
Doenças do Cão/microbiologia , Ehrlichia canis/classificação , Ehrlichia canis/isolamento & purificação , Ehrlichiose/veterinária , Animais , Sangue/microbiologia , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Cães , Ehrlichia canis/genética , Ehrlichiose/microbiologia , Dados de Sequência Molecular , Peru , Filogenia , RNA Ribossômico 16S/genética , Análise de Sequência de DNA , Homologia de Sequência do Ácido NucleicoRESUMO
An epidemiological study was conducted in a highland rural community in Peru to determine risk factors for canine echinococcosis caused by Echinococcus granulosus. Dogs were diagnosed using a coproantigen enzyme-linked immunosorbent assay (ELISA). Dog owners were interviewed prior to stool collection and asked for attitudes, practices and beliefs likely to be associated with local patterns of E. granulosus transmission. Univariate and multivariate analysis were used to determine odds ratios (OR) and their 95% confidence intervals (CI). The main risk factors found to be significantly associated with canine echinococcosis by univariate analysis were dog age (3-25 months) (OR, 5.14; CI, 1.7-15.7), female sex (OR, 4.3; CI, 1.4-13.3) and having been fed hydatid infected offal (OR, 2.9; 95% CI, 1.0-8.6). There was complete lack of knowledge about echinococcosis transmission. In addition to periodic dog treatment, control programs need to emphasize education of the human population to increase knowledge of parasite transmission and to change human practices associated with high rates of infection.
Assuntos
Coccidiose/epidemiologia , Coccidiose/veterinária , Doenças do Cão/epidemiologia , Doenças do Cão/parasitologia , Echinococcus granulosus/isolamento & purificação , Doenças Endêmicas , Animais , Antígenos de Protozoários/análise , Coccidiose/parasitologia , Coccidiose/transmissão , Doenças do Cão/transmissão , Cães , Ensaio de Imunoadsorção Enzimática/veterinária , Fezes/parasitologia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Análise Multivariada , Peru/epidemiologia , Fatores de Risco , Zoonoses/parasitologiaRESUMO
No evidence of Echinococcus granulosus infection has been described in the coastal region of Peru, with the exception of the capital city of Lima. Anecdotal evidence suggests the existence of a focus of echinococcosis in the coastal city of Chincha, located south of Lima. We conducted a preliminary epidemiologic study in Chincha, which included an ultrasound, chest radiography, and serologic survey of abattoir workers, a review of medical records from local hospitals, and examination of the intestines of stray dogs to determine the presence of canine echinococcosis. Among 25 abattoir workers examined for the presence of cystic echinococcosis, we found three (12%) subjects with echinococcal cysts. A review of medical records showed a surgical incidence of 32/100,000 for the period 1996-1998. Three of 48 dogs (6.25%) were found to be infected with E. granulosus tapeworms. This study demonstrates the existence of an undocumented endemic focus of E. granulosus previously unknown in the coastal region of Peru.