RESUMO
A 26-year-old woman presented with a 2-day history of fever peaking to 39 degrees C and cold shivers that developed after a 2-weeks trip to Guatemala and Belize. Prior to the fever the patient had felt symptoms of a common cold and general malaise. Moreover, she complained of generalised myalgia and nausea. She had taken paludrine as a prophylactic against malaria. Borrelia spirochaetes, the pathogen of relapsing fever, were detected in a thick blood smear preparation. On the basis of the anamnesis, geography and specific exposure, the patient had a form of relapsing fever that is transmitted by ticks and not by lice: tick-borne relapsing fever. She was treated with doxycycline, 100 mg b.i.d. for 7 days. She could be discharged home in good condition after 2 days.
Assuntos
Antibacterianos/uso terapêutico , Borrelia/isolamento & purificação , Doxiciclina/uso terapêutico , Febre Recorrente/diagnóstico , Viagem , Adulto , Belize , Feminino , Guatemala , Humanos , Febre Recorrente/sangue , Febre Recorrente/tratamento farmacológico , Resultado do Tratamento , Clima TropicalRESUMO
In a retrospective study, we performed two preventive antibiotic policies in 60 severly burned patients. All patients with a Burn Surface Area (BSA) of > 40 percent received ceftazidime-amikacin in Fort de France and piperacillin-netilmicin in Lyon. In Fort de France, 20 percent of patients developed septic shock with a mortality rate of 67 percent. Gram negative bacilli were always responsible for septic shock, of which 50 percent were resistant to initial antibiotics. In Fort de France, the bacteriological ecology in the burn centre showed less methicillin-resistant Staphylococcus aureus (MRSA) than the hospital (p < 0.05) and the same sensitivity for Pseudomonas aeruginosa. In Lyon, 37 percent of burn patients had septic shock with a mortality rate of 82 percent. In 91 percent, responsible isolates were multiresistant to initial antibiotics (p < 0.05). Bacteriological ecology of the burn centre was different from the hospital with a MRSA rate of 36.6 percent (p<0.02) and 54 percent of multiresistant Pseudomonas aeruginosa ( p < 0.05). Preventive antibiotics appear to be ineffective in severely ill burned patients. (AU)