Mefloquina en el tratamiento de la leishmaniasis cutánea en un área endémica de Leishmania (Viannia) braziliensis

Publicación a texto completo no autorizada por el autorEvalúa la eficacia de la mefloquina en una región endémica de leismaniasis cutánea por Leishmania (Viannia) braziliensis, considerando que esta droga, de administración oral, eficaz en el tratamiento de la malaria, con vida media prolongada y efectos colaterales poco frecuentes podría ser menos tóxica y de administración más fácil al ser comparada con los antimoniales pentavalentes. En Corte de Pedra, poblado ubicado en el litoral sur del Estado de Bahia en Brasil, se administró tratamiento, aleatoriamente a diez pacientes portadores de lesiones leishmaniásicas. Ellos fueron subdivididos en dos grupos de cinco pacientes. El primer grupo recibió mefloquina por vía oral a la dosis de 250 mg/día, durante seis días. Luego de un intervalo de tres semanas se repitió el mismo esquema. El segundo grupo recibió antimoniato de meglumina (Glucantime®) diariamente, por vía endovenosa, en la dosis de 20 mg/kg por 20 días. En el grupo tratado con mefloquina solo un paciente cicatrizó la lesión después de, inclusive el segundo ciclo. En este grupo, un paciente con cuatro lesiones presentó una nueva lesión durante el primer ciclo de tratamiento. La evolución de los otros tres fue lenta y luego de nueve semanas ninguno de ellos había presentado cicatrización de la lesión entretanto que permanecían con gran infiltración y signos evidentes de actividad. El otro grupo, tratado con Glucantime® presentó evidente mejoría en el mismo período de tiempo. No hubo evidencia clínica de mejoría en los pacientes con leishmaniasis cutánea tratados con mefloquina.Trabajo académic

Pneumocystis jirovecii pneumonia as a debut of acquired immunodeficiency syndrome (AIDS) in the COVID-19 pandemic era, a case report

Varón de 42 años, ingresa por el servicio de emergencias presentando dificultad respiratoria progresiva, malestar general y fiebre, se decide hospitalizar en esta institución con el diagnóstico de Insuficiencia Respiratoria Aguda por neumonía viral, se requirió descartar COVID-19 por hallazgos sugestivos y se obtuvo prueba molecular negativa. Mediante pruebas de laboratorio se contó con prueba ELISA VIH (+), teniendo al momento la sospecha de neumonía atípica por una infección oportunista en el supuesto caso de un paciente inmunosuprimido, se solicitaron otros exámenes complementarios (Western-Blot, Linfocitos T CD4) para la posterior confirmación del Virus de Inmunodeficiencia Humana (VIH). Finalmente, fue diagnosticado como neumonía por Pneumocystis jirovecii teniendo en cuenta que no se presentó el patrón típico radiológico y cumpliendo otros factores de riesgo asociados se obtuvo una evolución favorable del paciente.A 42-year-old man was admitted to the emergency department presenting progressive respiratory distress, general discomfort and fever, he was hospitalized in this institution with the diagnosis of Acute Respiratory Failure due to viralpneumonia, it was required to rule out COVID-19 due to suggestive findings by Computer Tomography (CT) chest. A negative molecular test was obtained. Through laboratory tests, an ELISA HIV (+) test was available. It was suspectedatypical pneumonia due to an opportunistic infection in the case of an immunocompromised patient, other complementary tests were requested (Western-Blot, CD4 T lymphocytes) to the subsequent confirmation of the Human Immunodeficiency Virus (HIV). Finally, it was diagnosed as Pneumonia Pneumocystis Jirovecii (PJP), highlighting the fact that the typicalradiological pattern did not appear on the CT chest but fulfilling other associated risk factors from the patient, letting to a favorable evolution of the patient was obtained with PJP treatment

Accidente ofídico: análisis del abordaje terapéutico en una entidad de salud privada de Lima, Perú

Snakebite accidents are a public health problem in tropical and subtropical countries. In Peru most of these events occur in the jungle, however, they are also reported in coastal cities. Lima, is a city in a desert coast valley, where it is not usual to attend ophidian accidents and even less in a private emergency room. Most snakebite deaths and serious consequences are preventable, provided that safe and effective antidotes are made more widely available and accessible. We present the case of a 39-year-old patient who suffered an accident due to a snake bite in Lima. Quick and effective communication with the different levels involved helped us to adequately face this case. We present this text to strengthen knowledge and find opportunities to improve a real problem that can be fatal without proper management. Los accidentes por mordedura de serpiente son un problema de salud pública en países tropicales y subtropicales. En el Perú la mayoría de estos eventos ocurren en la selva, sin embargo, también se reportan en ciudades costeras. Lima, es una ciudad en un valle de costa en medio del desierto, donde no es usual atender accidentes ofídicos y menos aún en la emergencia de una entidad de salud privada. La mayoría de las muertes y consecuencias graves por mordedura de serpiente son prevenibles, en la medida que se logre disponibilidad y accesibilidad de antídotos seguros y eficaces. Se presenta el caso de un paciente de 39 años quien sufrió un accidente por mordedura de serpiente en el Departamento de Lima. La comunicación rápida y eficaz con los diferentes estamentos involucrados nos ayudó a enfrentar adecuadamente este caso. Presentamos este texto para afianzar conocimientos y encontrar oportunidades de mejora de un problema real y que puede ser mortal sin manejo adecuado.&nbsp

Mordedura de araña: reporte de un caso asociado a reacción de hipersensibilidad al suero antiloxocélico y aproximación al manejo general de estos accidentes

Loxoscelism is a clinical picture produced by the bite of the Loxosceles laeta spider. In Peru in 2021 almost 400 cases have been reported so far this year. The forms of presentation are cutaneous loxoscelism, which is the most frequent form, and cutaneous-visceral loxoscelism, less frequent but more deadly. Our case is a 33-year-old patient who came to the emergency room due to erythema and edema on the back of the arm not associated with pain; he stated that he had been bitten by a spider 48 hours before admission. He is hospitalized for monitoring, administration of antiloxocelic serum and antibiotics. In the evolution in hospitalization, he develops manifestations of cutaneous Loxocelism, however, other manifestations appear, distant from the original lesion, such as rash, itching and numbness in the hands and feet, and other parts of the body progressively; A dose of antiloxocelic serum, antibiotics, corticosteroids and antihistamines were administered. An allergic reaction to the administered serum is suspected, this would be part of the early adverse reactions to antivenoms. On the other hand, the management of Loxocelism constitutes a therapeutic challenge due to the fact that there is no unanimity in its treatment, however, important considerations must be taken into account for its timely approach. It is also important to recommend preventive measures to the general population to avoid this type of accident.El Loxoscelismo es un cuadro clínico producido por la mordedura de la araña Loxosceles laeta. En el Perú en el 2021 se han reportado casi 400 casos en lo que va del año. Las formas de presentación son el loxoscelismo cutáneo, que es la forma más frecuente y loxoscelismo cutáneo-visceral, menos frecuente pero más mortal. Nuestro caso es un paciente de 33 años que acudió a la emergencia por eritema y edema en cara posterior de brazo asociado a dolor; manifestó haber sido mordido por una araña 48 horas antes del ingreso. Se hospitaliza para monitoreo, administración de suero antiloxocélico y antibióticos. En la evolución en hospitalización desarrolla manifestaciones de Loxocelismo cutáneo, sin embargo, aparecen otras manifestaciones, distantes a la lesión primigenia, como rash, prurito y adormecimiento en manos y pies, y otras partes del cuerpo de forma progresiva; Se administró una dosis de suero antiloxocélico, antibióticos, corticoides y clorfenamina. Se sospecha de una reacción alérgica al veneno de araña o al suero administrado, esta último se enmarcaría dentro las reacciones adversas tempranas a los antivenenos. El loxocelismo es un desafío para la salud pública debido a que no hay unanimidad en su tratamiento, sin embargo hay que tener en cuenta consideraciones importantes para su manejo oportuno. Además es relevante recomendar a la población en general las medidas preventivas para evitar este tipo de accidentes

Pandemic influenza in a southern hemisphere setting: the experience in Peru from May to September, 2009

This paper presents a description of Peru’s experience with pandemic H1N1 influenza 2009. It is based on data from four main surveillance systems: a) ongoing sentinel surveillance of influenza-like illness cases with virological surveillance of influenza and other respiratory viruses; b) sentinel surveillance of severe acute respiratory infections and associated deaths; c) surveillance of acute respiratory infections in children under the age of five years and pneumonia in all age groups; and d) case and cluster surveillance. On 9 May 2009, the first confirmed case of pandemic H1N1 influenza in Peru was diagnosed in a Peruvian citizen returning from New York with a respiratory illness. By July, community transmission of influenza had been identified and until 27 September 2009, a total of 8,381 cases were confirmed. The incidence rate per 10,000 persons was 4.4 (in the 0–9 year-olds) and 4.1 (in the 10–19 year-olds). During epidemiological weeks (EW)* 26 to 37, a total of 143 fatal cases were notified (a case fatality of 1.71%, based on confirmed cases). The maximum peak in the number of cases was reached in EW 30 with 37 deaths. Currently, the impact of the pandemic in the Peruvian population has not been too severe, and fortunately, healthcare centres have not been overwhelmed. However, the future of this pandemic is uncertain and despite the fact that our country has not been seriously affected, we should be prepared for upcoming pandemic waves

Spatial and Temporal Characteristics of the 2009 A/H1N1 Influenza Pandemic in Peru

Background: Highly refined surveillance data on the 2009 A/H1N1 influenza pandemic are crucial to quantify the spatial and temporal characteristics of the pandemic. There is little information about the spatial-temporal dynamics of pandemic influenza in South America. Here we provide a quantitative description of the age-specific morbidity pandemic patterns across administrative areas of Peru. Methods: We used daily cases of influenza-like-illness, tests for A/H1N1 influenza virus infections, and laboratory-confirmed A/H1N1 influenza cases reported to the epidemiological surveillance system of Peru’s Ministry of Health from May 1 to December 31, 2009. We analyzed the geographic spread of the pandemic waves and their association with the winter school vacation period, demographic factors, and absolute humidity. We also estimated the reproduction number and quantified the association between the winter school vacation period and the age distribution of cases. Results: The national pandemic curve revealed a bimodal winter pandemic wave, with the first peak limited to school age children in the Lima metropolitan area, and the second peak more geographically widespread. The reproduction number was estimated at 1.6–2.2 for the Lima metropolitan area and 1.3–1.5 in the rest of Peru. We found a significant association between the timing of the school vacation period and changes in the age distribution of cases, while earlier pandemic onset was correlated with large population size. By contrast there was no association between pandemic dynamics and absolute humidity. Conclusions: Our results indicate substantial spatial variation in pandemic patterns across Peru, with two pandemic waves of varying timing and impact by age and region. Moreover, the Peru data suggest a hierarchical transmission pattern of pandemic influenza A/H1N1 driven by large population centers. The higher reproduction number of the first pandemic wave could be explained by high contact rates among school-age children, the age group most affected during this early wave

Venezuelan Equine Encephalitis and Upper Gastrointestinal Bleeding in Child

Venezuelan equine encephalitis (VEE) is reemerging in Peru. VEE virus subtype ID in Peru has not been previously associated with severe disease manifestations. In 2006, VEE virus subtype ID was isolated from a boy with severe febrile disease and gastrointestinal bleeding; the strain contained 2 mutations within the PE2 region

Efficacy of mefloquine in the treatment of skin leishmaniasis in an endemic area of Leishmania (Viannia) braziliensis

O objetivo deste trabalho foi avaliar a eficácia da mefloquina numa região endêmica de leishmaniose cutânea por Leishmania (Viannia) braziliensis, considerando que esta droga de administração oral, eficaz no tratamento da malária, com meia vida prolongada e efeitos colaterais pouco freqüentes poderia ser menos tóxica e de mais fácil administração, quando comparada com os antimoniais pentavalentes. Em Corte de Pedra, no litoral sul do Estado da Bahia, foram tratados, aleatoriamente, dez pacientes portadores de lesões leishmanióticas, subdivididos em dois grupos. O primeiro grupo recebeu mefloquina pela via oral, dose de 250mg/dia, durante seis dias, repetindo-se o mesmo esquema após intervalo de três semanas. O segundo grupo recebeu antimoniato de meglumina (Glucantime®) diariamente, pela via endovenosa, na dose de 20mg/kg por 20 dias. Do grupo da mefloquina só um paciente apresentou cicatrização depois do segundo ciclo. Um desses, com quatro lesões apresentou nova lesão durante o primeiro ciclo de tratamento. A evolução dos outros três foi lenta sendo que em nove semanas nenhum deles tinha cicatrizado as úlceras que permaneciam com grande infiltração e sinais evidentes de atividade. O grupo tratado com Glucantime® apresentou evidente melhora.The aim of this study was to evaluate the efficacy of mefloquine in the treatment of skin leishmaniasis in patients infected with Leishmania (Viannia) braziliensis at an endemic region. Mefloquine is an oral drug effective against malaria with a prolonged half-life, less toxicity and easier administration than pentavalent antimonials. At Corte de Pedra in the Southern litoral of Bahia State, two randomized groups of ten patients with leishmaniasis were treated. The first group was treated with oral mefloquine, 250mg per day in a single dose for six days and repeated three weeks later. The second group received meglumine antimoniate (Glucantime®), 20mg/kg daily administered intravenously for 20 days. Only one patient in the group treated with mefloquine showed evidence of clinical success. During treatment, one patient with four lesions developed a new lesion. The other three patients with clinical leismaniasis did not show evidence of clinical success after nine weeks of treatment. The group treated with Glucantime® showed evident clinical improvement of the skin lesions