ResumenEl síndrome febril agudo se refiere a un conjunto de enfermedades que cursan con fiebre en el contexto de exposición en áreas tropicales y que constituyen un motivo de consulta frecuente en el servicio de urgencias. Este artículo revisa el enfoque clínico del síndrome febril agudo en Colombia y de las enfermedades más prevalentes o graves que lo causan. Se presenta el enfoque sindromático y se establece una revisión sucinta de los síntomas principales, signos de alarma, tratamiento, prevención y notificación en el sistema de vigilancia en salud pública.Palabras clave: Síndrome febril agudo; Malaria; Dengue; Virus chikungunya; Hepatitis; Fiebre amarilla; Infecciones por rickettsia; Leptospirosis; Absceso hepático; Fiebre hemorrágica ébola
Clinical approach to acute febrile syndome in Colombia AbstractAcute febrile syndrome refers to a group of diseases with fever as a main symptom, in a context of living in or having been exposed to tropical climates. It is a frequent cause for consultation in the emergency room. This paper reviews the clinical approach to acute febrile syndrome and the most prevalent or severe causes. We present the syndromatic approach to the patient and a short review of the main symptoms, alarm signs, treatment, prevention and notification to the public health surveillance system of the most frequent causes.Keywords: Acute febrile syndrome; Malaria; Dengue; Chikungunya virus; Hepatitis; Yellow fever; Rickettsia infections; Leptospirosis; Liver abscess; Hemorrhagic fever ebola
IntroducciónColombia es un país ubicado en el trópico y endémico para distintas enfermedades febriles agudas de origen infeccioso, de las cuales, en el caso de malaria se puede realizar un diagnóstico oportuno y rápido, no así en las otras causas de sín-drome febril no palúdico, por lo que quedan sin diagnóstico etiológico claro. A pesar del intento de la OMS por generar algoritmos diagnósticos y terapéuticos en la enfermedad febril aguda, todavía existe mucha confusión acerca del enfoque y manejo del paciente con fiebre sin foco aparente en el servicio de urgencias y, más aún, en su seguimiento hospitalario e incluso ambulatorio 1-3 .Se define síndrome febril agudo (SFA) como el estado mór-bido con inicio repentino de fiebre, de menos de 7 días de evolución, en pacientes entre 5 y 65 años, en los cuales no se hayan identificado signos ni síntomas relacionados con un foco infeccioso aparente 4 . Actualmente, en Colombia existen más de 60 enfermedades infectocontagiosas consideradas de interés en salud pública, con un comportamiento endemoepidémico en más del 85% del territorio nacional, que se manifiestan a través de SFA 5 . Debido a la diversidad de enfermedades causantes y a la posibilidad de que el cuadro corresponda a un caso de malaria, dengue, rickettiosis u otras enfermedades potencialmente letales y de importancia en salud pública, es muy importante para el médico colombiano tener la capacidad de abordar los casos para garantizar una atención apropiada y una selección de las pruebas diagnósticas apropiadas...
Candidemia is associated with a high mortality rate. Age and shock increase mortality, while the use of fluconazole was shown to be a protective factor. A higher resistance rate with new breakpoints was noted.
Pseudomonas aeruginosa is an important and frightening microorganism for patients suffering from cancer. Multiresistant P. aeruginosa (MRPA) may appear as a consequence of exposure to multiple antibiotics or from a breakdown in infection control practices. This article reports an MRPA outbreak in a cancer treatment centre and the consequent case control study. Mechanical ventilation was identified as being the main risk factor for developing MRPA colonisation or infection; molecular analysis confirmed the outbreak. A multifaceted strategy was adopted, involving reinforcing hand-washing practices, contact isolation, antibiotic restriction and suction devices for mechanically-ventilated patients. MRPA was controlled and the outbreak ended. Such strategy may be effective in controlling MRPS in low-resource environments amongst high risk cancer patients.
IntroductionPatients with febrile neutropenia (FN) exhibit changes in extracellular fluid that may alter the plasma concentrations of beta-lactams and result in therapeutic failure or toxicity. We evaluated the pharmacokinetics of piperacillin/tazobactam in patients with hematological malignancies and FN after receiving chemotherapy at a primary public cancer center.MethodsThis was an open, nonrandomized, observational, descriptive, and prospective study. Samples from 15 patients with hematological malignancies and FN were evaluated after the administration of chemotherapy. Five blood samples were taken from each patient when the antibiotic level was at steady-state 10, 60, 120, 180, and 350 min after each dose. Antibiotic concentrations were measured using gel diffusion with Bacillus subtilis. All study participants provided written informed consent.ResultsWe investigated the pharmacokinetics of piperacillin in 14 patients between the ages of 18 years and 59 years and with a mean absolute neutrophil count of 208 cells per mm3 (standard deviation (SD) ± 603.2). The following pharmacokinetic measurements were obtained: maximum concentration, 94.1–1133 mg/L; minimum concentration, 0.47–37.65 mg/L; volume of distribution, 0.08–0.65 L/kg (mean, 0.34 L/kg); drug clearance (CL), 4.42–27.25 L/h (mean, 9.93 L/h); half-life (t1/2), 0.55–2.65 h (mean, 1.38 h); and area under the curve, 115.12–827.16 mg · h/L.ConclusionPatients with FN after receiving chemotherapy exhibited significant variations in the pharmacokinetic parameters of piperacillin compared with healthy individuals; specifically, FN patients demonstrated an increase in t1/2 and decreased CL.
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