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Objective: Geographical information systems (GIS) have been extensively used for the development of epidemiological maps of tropical diseases, however not yet specifically for Zika virus (ZIKV) infection. Methods: Surveillance case data of the ongoing epidemics of ZIKV in the Tolima department, Colombia (2015-2016) were used to estimate cumulative incidence rates (cases/100,000 pop.) to develop the first maps in the department and its municipalities, including detail for the capital, Ibagué. The GIS software used was Kosmo Desktop 3.0RC1®. Two thematic maps were developed according to municipality and communes incidence rates. Results: Up to March 5, 2016, 4,094 cases of ZIKV were reported in Tolima, for cumulated rates of 289.9 cases/100,000 pop. (7.95% of the country). Burden of ZIKV infection has been concentrated in its east area, where municipalities have reported >500 cases/100,000 pop. These municipalities are bordered by two other departments, Cundinamarca (3,778 cases) and Huila (5,338 cases), which also have high incidences of ZIKV infection. Seven municipalities of Tolima ranged from 250-499.99 cases/100,000 pop., of this group five border with high incidence municipalities (>250), including the capital, where almost half of the reported cases of ZIKV in Tolima are concentrated. Conclusions: Use of GIS-based epidemiological maps helps to  guide decisions for the prevention and control of diseases that represent significant issues in the region and the country, but also in emerging conditions such as ZIKV.

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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.

Background: The febrile patient from tropical areas, in which emerging arboviruses are endemic, represent a diagnostic challenge and potential co-infections with other pathogens (i.e bacteria or parasites) are usually overlooked. Objectives: We present a case of an elderly woman diagnosed with dengue, chikungunya and Leptospira interrogans co-infection. Study Design: Case report. Results: 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, 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 hours 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 IgM, NS1 ELISA, MAT for Leptospira interrogans and RT-PCR for chikungunya, were positive. Discussion: This case illustrates a multiple co-infection in a febrile patient from a tropical area of Latin America that evolved to death.