Comparison of clinical characteristics of Zika and dengue symptomatic infections and other acute illnesses of unidentified origin in Mexico.

BACKGROUND: Our purpose was to provide a detailed clinical description, of symptoms and laboratory abnormalities, and temporality in patients with confirmed Zika and dengue infections, and other acute illnesses of unidentified origin (AIUO). METHODS/ PRINCIPAL FINDINGS: This was a two-year, multicenter, observational, prospective, cohort study. We collected data from patients meeting the Pan American Health Organization's modified case-definition criteria for probable Zika infection. We identified Zika, dengue chikungunya by RT-PCR in serum and urine. We compared characteristics between patients with confirmed Zika and dengue infections, Zika and AIUO, and Dengue and AIUO at baseline, Days 3,7,28 and 180 of follow-up. Most episodes (67%) consistent with the PAHO definition of probable Zika could not be confirmed as due to any flavivirus and classified as Acute Illnesses of Unidentified Origin (AIUO). Infections by Zika and dengue accounted for 8.4% and 16% of episodes. Dengue patients presented with fever, generalized non-macular rash, arthralgia, and petechiae more frequently than patients with Zika during the first 10 days of symptoms. Dengue patients presented with more laboratory abnormalities (lower neutrophils, lymphocytosis, thrombocytopenia and abnormal liver function tests), with thrombocytopenia lasting for 28 days. Zika patients had conjunctivitis, photophobia and localized macular rash more frequently than others. Few differences persisted longer than 10 days after symptoms initiation: conjunctivitis in Zika infections, and self-reported rash and petechia in dengue infections. CONCLUSIONS: Our study helps characterize the variety and duration of clinical features in patients with Zika, dengue and AIUO. The lack of diagnosis in most patients points to need for better diagnostics to assist clinicians in making specific etiologic diagnoses.

[Antimicrobial resistance trends in pathogens isolated from nosocomial infections]. / Tendencias de resistencia antimicrobiana en patógenos aislados de infecciones nosocomiales.

BACKGROUND: The treatment of nosocomial infections is hindered by the increasing antimicrobial resistance pattern of germs that cause them. The objective was to assess trends in resistance of bacteria isolated from nosocomial infections. METHODS: Retrospective study from 2009 to 2012 on a third level hospital in Chiapas. RESULTS: 1300 germs were obtained, 62.3 % Gram negative bacteria, 22.8 % Gram positive and 14.9 % yeasts; imipenem resistance of P. aeruginosa went from 47.1 to 60.5 %, E. coli showed an increased resistance to aztreonam, cefepime and ceftazidime, A. baumannii increased resistance to amikacin, cefepime, ceftazidime and ciprofloxacin. Klebsiella pneumoniae decreased its resistance to amikacin and piperacillin/tazobactam; vancomycin resistance ranges from 3.6 to 25.5 %. CONCLUSION: Gram negative organisms predominated, showing increasing trends in antimicrobial resistance. There was a proportional increase in the incidence of infection from E. coli, C. tropicalis and S. haemolyticus. It is essential to have programs and plans for the rational and evidence-based use of antimicrobials, as well as dissemination and adherence to clinical practice guidelines and the implementation of innovative programs for the prevention and control of nosocomial infections, isolation techniques and general care.

Introducción: el tratamiento de las infecciones nosocomiales se dificulta por la tendencia al incremento de la resistencia a antimicrobianos de los gérmenes que las causan. El objetivo fue evaluar las tendencias en la resistencia de las bacterias de aislados de infección nosocomial. Métodos: estudio retrospectivo de 2009 a 2012 en un hospital de tercer nivel en Chiapas. Resultados: fueron obtenidos 1300 gérmenes, 62.3 % bacterias Gram negativas, 22.8 % Gram positivas y 14.9 % levaduras; Pseudomonas aeruginosa pasó del 47.1 al 60.5 % de resistencia a imipenem; Escherichia coli mostró un aumento en la resistencia a aztreonam, cefepime y ceftazidima; Acitenobacter baumannii incrementó su resistencia a amikacina, cefepime, ceftazidima y ciprofloxacino; Klebsiella pneumoniae disminuyó su resistencia a amikacina y piperacilina/tazobactam; la resistencia a vancomicina fue del 3.6 al 25.5 %. Conclusiones: predominaron los gérmenes Gram negativos y mostraron tendencias al incremento en la resistencia antimicrobiana. Hubo un aumento proporcional de la incidencia de infección por E. coli, Candida tropicalis y Staphylococcus haemolyticus. Es indispensable contar con planes y programas para el uso racional y basado en evidencia de antimicrobianos, así como la difusión y el apego a las guías de práctica clínica y la implementación de programas novedosos para la vigilancia y el control de las infecciones hospitalarias, las técnicas de aislamiento y los cuidados generales.