Rickettsia rickettsii and Rickettsia typhi in hospitalized children diagnosed with Pediatric Multisystemic Inflammatory Syndrome in Merida, Yucatan.

Multisystem Inflammatory Syndrome in Children (MIS-C) presents with fever, fatigue, elevated inflammatory markers (acute phase reactants), and a history of exposure to SARS-CoV-2 or positive antibodies to SARS-CoV-2. As the COVID-19 pandemic unfolded, the risk of MIS-C in the pediatric population increased. However, exposure to other viruses and the presence of SARS-CoV-2 positive antibodies in children hospitalized for various pathogen-associated illnesses will also remain common and may complicate differential diagnoses with diseases endemic to the region such as rickettsial diseases. The objective was to highlight the desirability of medical personnel systematically incorporating rickettsiosis as a differential diagnosis for MIS-C when studying a child with fever, non-specific symptoms, and elevated inflammatory markers. In conclusion MIS-C should be considered in children with elevated inflammatory markers when there is a history of COVID-19 and they also meet criteria that have already been established by international agencies, such as CDC and WHO.

Rickettsia rickettsii and Rickettsia typhi in hospitalized children diagnosed with Pediatric Multisystemic Inflammatory Syndrome in Merida, Yucatan

Abstract Multisystem Inflammatory Syndrome in Children (MIS-C) presents with fever, fatigue, elevated inflammatory markers (acute phase reactants), and a history of exposure to SARS-CoV-2 or positive antibodies to SARS-CoV-2. As the COVID-19 pandemic unfolded, the risk of MIS-C in the pediatric population increased. However, exposure to other viruses and the presence of SARS-CoV-2 positive antibodies in children hospitalized for various pathogen-associated illnesses will also remain common and may complicate differential diagnoses with diseases endemic to the region such as rickettsial diseases. The objective was to highlight the desirability of medical personnel systematically incorporating rickettsiosis as a differential diagnosis for MIS-C when studying a child with fever, non-specific symptoms, and elevated inflammatory markers. In conclusion MIS-C should be considered in children with elevated inflammatory markers when there is a history of COVID-19 and they also meet criteria that have already been established by international agencies, such as CDC and WHO

Assessment of the quality of the vital registration system for under-5 mortality in Yucatan, Mexico.

INTRODUCTION: Vital registration is an important element in health information systems which can inform policy and strengthen health systems. Mexico has a well-functioning vital registration system; however, there is still room for improvement, especially for deaths of children under 5. This study assesses the quality of the vital registration system in capturing deaths and evaluates the quality of cause of death certification in under-5 deaths in Yucatan, Mexico. METHODS: We collected information on under-5 deaths that occurred in 2015 and 2016 in Yucatan, Mexico. We calculated the Vital Statistics Performance Index (VSPI) to have a general assessment of the vital registration performance. We examined the agreement between vital registration records and medical records at the individual and population levels using the chance-corrected concordance (CCC) and cause-specific mortality fraction (CSMF) accuracy as quality metrics. RESULTS: We identified 966 records from the vital registry for all under-5 deaths, and 390 were linked to medical records of deaths occurring at public hospitals. The Yucatan vital registration system captured 94.8% of the expected under-5 deaths, with an overall VSPI score of 87.2%. Concordance between underlying cause of death listed in the vital registry and the cause determined by the medical record review varied substantially across causes, with a mean overall chance-corrected concordance across causes of 6.9% for neonates and 46.9% for children. Children had the highest concordance for digestive diseases, and neonates had the highest concordance for meningitis/sepsis. At the population level, the CSMF accuracy for identifying the underlying cause listed was 35.3% for neonates and 67.7% for children. CONCLUSIONS: Although the vital registration system has overall good performance, there are still problems in information about causes of death for children under 5 that are related mostly to certification of the causes of death. The accuracy of information can vary substantially across age groups and causes, with causes reported for neonates being generally less reliable than those for older children. Results highlight the need to implement strategies to improve the certification of causes of death in this population.

Maternal mortality during the COVID-19 pandemic in Mexico: a preliminary analysis during the first year.

BACKGROUND: In Mexico, the COVID-19 pandemic led to preventative measures such as confinement and social interaction limitations that paradoxically may have aggravated healthcare access disparities for pregnant women and accentuated health system weaknesses addressing high-risk patients' pregnancies. Our objective is to estimate the maternal mortality ratio in 1 year and analyze the clinical course of pregnant women hospitalized due to acute respiratory distress syndrome and COVID-19. METHODS: A retrospective surveillance study of the national maternal mortality was performed from February 2020-February 2021 in Mexico related to COVID-19 cases in pregnant women, including their outcomes. Comparisons were made between patients who died and those who survived to identify prognostic factors and underlying health conditions distribution. RESULTS: Maternal Mortality Ratio increased by 56.8% in the studied period, confirmed COVID-19 was the cause of 22.93% of cases. Additionally, unconfirmed cases represented 4.5% of all maternal deaths. Among hospitalized pregnant women with Acute Respiratory Distress Syndrome consistent with COVID-19, smoking and cardiovascular diseases were more common among patients who faced a fatal outcome. They were also more common in the age group of < 19 or > 38. In addition, pneumonia was associated with asthma and immune impairment, while diabetes and increased BMI increased the odds for death (Odds Ratio 2.30 and 1.70, respectively). CONCLUSIONS: Maternal Mortality Ratio in Mexico increased over 60% in 1 year during the pandemic; COVID-19 was linked to 25.4% of maternal deaths in the studied period. Lethality among pregnant women with a diagnosis of COVID-19 was 2.8%, and while asthma and immune impairment increased propensity for developing pneumonia, obesity and diabetes increased the odds for in-hospital death. Measures are needed to improve access to coordinated well-organized healthcare to reduce maternal deaths related to COVID-19 and pandemic collateral effects.

Influenza in Yucatan in 2018: Chronology, characteristics and outcomes of ambulatory and hospitalized patients.

INTRODUCTION: Influenza season is expected between October and February in the northern hemisphere, including Mexico. Previous studies suggested that transmission peak may occur earlier in Yucatan, a state in southeast Mexico. OBJECTIVES: (a) Describe the seasonality of 2018 influenza cases seen at O´Horan hospital, statewide, and nationwide; (b) analyze the characteristics, clinical manifestations and outcomes of ambulatory and hospitalized patients; (c) analyze fatal outcomes occurrence among vaccinated and unvaccinated individuals. METHODS: Retrospective analytic cohort of all confirmed influenza cases assisted at O´Horan hospital during 2018, along with a chronologic graphic description of the statewide epidemic curve from the epidemiological surveillance registries. RESULTS: A total of 264 influenza cases were analyzed; 145 (55%) were female; 26% were vaccinated. Health workers and unvaccinated individuals were more prone to develop severe cases. Dyspnea and tachypnea were strong predictors of hospitalization; headache, myalgias, arthralgias and rhinorrhea correlated inversely. 236 (89.47%) cases occurred in July and 22 of the 23 deaths occurred before October. No fatal outcomes were observed among vaccinated individuals. Influenza AH1N1 represented 83.6% of serotyped cases. DISCUSSION: Onset of influenza season in Yucatan may reflect a need for rethinking timing of vaccination and of preventive campaigns, as most cases occurred before vaccination period.

Emergency treatment for a venomous snakebite accident in rural southern Mexico.

In Latin America, 51 995 emergencies and 337 deaths are caused by snakebites yearly. Prompt and adequate treatment is crucial after an envenomation. We here report the case of a 40-year-old male agriculturalist, who was bitten by a venomous snake. Hours after the bite, he was admitted at the nearest clinic, diagnosed with type IV envenomation. After initial antivenom treatment he was transported to an urban hospital. Hemorrhage persisted and the patient developed compartmental syndrome and renal failure. The patient died 3 days after the accident. To reduce fatalities from snakebite envenomation, such as the case we here presented, there is a need for coordinated and multilevel approach, collaborative work and continual medical training.

Análisis de la mortalidad materna de los años 2013 a 2015 en el estado de Yucatán

RESUMEN Introducción La mortalidad materna se considera un indicador significativo de la calidad de los servicios de salud, así se conoce que aproximadamente un 95% de estas muertes en América Latina y el Caribe son prevenibles. Objetivos Determinar si la razón de muerte materna (RMM) en Yucatán es mayor a la media nacional durante los años 2013 a 2015. Material y Métodos Estudio transversal observacional en el que se analizaron los datos contenidos en los certificados de defunción de mujeres que fallecieron por causas directas relacionadas con el embarazo durante los años 2013 a 2015 en el estado de Yucatán. Los resultados obtenidos fueron comparados con los datos del Instituto Nacional de Estadística y Geografía (INEGI) mediante chi cuadrada. Resultados La RMM en Yucatán fue de 38,11%, 34,68% y 21,14%, para los años 2013, 2014 y 2015 respectivamente; en todos los casos mayores que la nacional. Las principales causas de muerte en el estado concuerdan con lo expuesto en la bibliografía, siendo éstas los desórdenes hipertensivos y las hemorragias. Conclusión La RMM durante los años 2013 a 2015 en el estado de Yucatán fue mayor a la media nacional. Es importante implementar medidas preventivas que permitan reducir esta disparidad en términos de mortalidad materna en el estado de Yucatán.

ABSTRACT Introduction Maternal Mortality is considered a significant indicator of the quality of the health services in any country. It is known that approximately 95% of these deaths in Latin America and the Caribbean are preventable. Objectives Our objective is to determine whether or not the Maternal Mortality Ratio (MMR) in Yucatan is higher than the national mean during the years 2013 to 2015. Materials and methods Transversal-observational study in pregnant women who died from direct causes related to pregnancy during the years 2013 to 2015 in Yucatan. Data from the National Institute of Statistics and Geography (INEGI) were used. Results In 2013 the MMR in Yucatan was 38,11% higher than the national mean, in 2014 the MMR of this state was 34,68% higher in comparison to the national mean and in 2015 the MMR was 21,14% higher than the national mean. The main causes of dead in the state of Yucatan are in agreement with the national causes which are hypertensive disorders and hemorrhagic disorders. Conclusions The MMR during the years 2013 to 2015 in the state of Yucatan was higher than the national average. It is important to implement preventive measures to reduce this disparity in terms of maternal mortality in the state of Yucatán.

Application of Artificial Neural Networks for Dengue Fever Outbreak Predictions in the Northwest Coast of Yucatan, Mexico and San Juan, Puerto Rico.

Modelling dengue fever in endemic areas is important to mitigate and improve vector-borne disease control to reduce outbreaks. This study applied artificial neural networks (ANNs) to predict dengue fever outbreak occurrences in San Juan, Puerto Rico (USA), and in several coastal municipalities of the state of Yucatan, Mexico, based on specific thresholds. The models were trained with 19 years of dengue fever data for Puerto Rico and six years for Mexico. Environmental and demographic data included in the predictive models were sea surface temperature (SST), precipitation, air temperature (i.e., minimum, maximum, and average), humidity, previous dengue cases, and population size. Two models were applied for each study area. One predicted dengue incidence rates based on population at risk (i.e., numbers of people younger than 24 years), and the other on the size of the vulnerable population (i.e., number of people younger than five years and older than 65 years). The predictive power was above 70% for all four model runs. The ANNs were able to successfully model dengue fever outbreak occurrences in both study areas. The variables with the most influence on predicting dengue fever outbreak occurrences for San Juan, Puerto Rico, included population size, previous dengue cases, maximum air temperature, and date. In Yucatan, Mexico, the most important variables were population size, previous dengue cases, minimum air temperature, and date. These models have predictive skills and should help dengue fever mitigation and management to aid specific population segments in the Caribbean region and around the Gulf of Mexico.

Epidemiologic profile and clinical course of four confirmed rickettsiosis cases in Southern Mexico during 2016.

Domestic animals can carry ticks or fleas, which constitute common vectors of rickettsial infections. The contact with them should be considered as suggestive of rickettsial infections in symptomatic patients. Misdiagnosis might occur in regions where other vector-borne diseases are endemic. Anamnesis is essential for an accurate clinical diagnosis.

Descripción de la variación estacional en la mortalidad materna de México y el estado de Yucatán 2002-2016 / Description of seasonal variation in maternal mortality in Mexico and the state of Yucatan between 2002 and 2016

Resumen Objetivo: Describir la distribución bimestral y anual de los casos de mortalidad materna en la República Mexicana y en el estado de Yucatán. Materiales y métodos: Estudio epidemiológico, observacional, transversal y retrospectivo que incluyó todos los registros de mortalidad materna directa asentados en las bases de datos de la Secretaría de Salud, de 2002 a 2016. La distribución de la razón de muerte materna esperada-observada se graficó por bimestres. Los análisis estadísticos se efectuaron con el programa Stata 14. Resultados: El registro de nacimientos anuales entre 2002 y 2016 en México fue, en promedio, de 2,549,398 con una tasa de natalidad bimestral promedio, en el estado de Yucatán, de 3.02 ± 0.32, con valores máximos en los meses de septiembre y octubre. La media anual de mortalidad materna fue de 1123 casos. El total de casos nacionales de mortalidad materna directa fue de 17,088 y de 269 en el estado de Yucatán (1.57%). En el análisis de distribución bimestral de los casos de mortalidad materna se observó una frecuencia uniforme (0.94-1.06) a nivel nacional y una distribución unimodal en el bimestre septiembre-octubre (0.76-1.42) en Yucatán. El riesgo relativo de mortalidad materna en el estado de Yucatán fue significativamente mayor en septiembre y octubre (RR = 0.57- IC95% 0.73:1.00; p < 0.05) periodo en el que ocurren casi un cuarto de los casos de mortalidad de todo el año. Conclusiones: La distribución estacional de la mortalidad materna nacional muestra mínimas variaciones bimestrales, pero en el estado de Yucatán se registran más casos entre septiembre y octubre, que a su vez coincide con la distribución de nacimientos en la entidad.

Abstract Objective: To describe the annual bimonthly distribution of cases of maternal mortality at the national and Yucatan state levels. Materials and methods: Retrospective cross-sectional study, which included all direct maternal mortality registries with ICD-10 letter "O" registered in the open access databases of the Mexican Ministry of Health, between 2002-2016. The distribution of expected/observed MM ratio was plotted by bimonthly. Statistical analyses were performed using Stata 14 statistical program. Results: In Mexico, an average of 2,549,398 births were recorded between 2002 and 2016, with an average bimonthly birth rate in the state of Yucatan of 3.02 ± 0.32, with maximum values in September and October. Throughout the country, an average annual maternal mortality rate of 1123 cases was recorded between 2002 and 2016. The total number of cases of direct maternal mortality was 17,088 at the national level and 269 in the state of Yucatan (1.57%). In the analysis of bimonthly distribution of cases of maternal mortality, a uniform bimonthly frequency (0.94-1.06) was observed at the national level, while a unimodal distribution was observed in the September-October bimonthly (0.76-1.42) for the state of Yucatan. The relative risk of maternal mortality in the state of Yucatan is significantly higher in September-October bimonthly (RR =0.57- CI95% 0.73:1.00; p < 0.05), period in which almost a quarter of the mortality cases occurred.

Síndrome de Eisenmenger en una paciente embarazada de 21 años / Eisenmenger syndrome in 21-year pregnant patient

Resumen ANTECEDENTES El síndrome de Eisenmenger es la cardiopatía congénita con mayor riesgo de mortalidad de las embarazadas. CASO CLÍNICO: Paciente primigesta de 21 años, con síndrome de Eisenmenger e insuficiencia cardiaca grado III NYHA e hipertensión arterial sistémica. El embarazo se interrumpió mediante cesárea a las 30 semanas, con recién nacido vivo de 1000 g, Apgar 3-7, 32 semanas de gestación por Capurro. Seis días después de la cesárea la paciente falleció debido a choque cardiogénico. El neonato falleció de insuficiencia respiratoria el décimo segundo día de vida extrauterina. CONCLUSIONES El caso aquí descrito permite reflexionar acerca de las oportunidades de mejora en la atención de las pacientes con síndrome de Eisenmenger. En el primer nivel de atención es importante centrarse en la educación y consejería específicas que permitan comprender a la paciente y su pareja los riesgos implícitos de su afección, pues la alternativa más segura hubiera sido evitar el embarazo. En el segundo nivel de atención ha de favorecerse siempre la práctica basada en evidencia y correcta coordinación en los equipos de salud que, en este caso particular, hubiera permitido que la paciente desde la semana 14 hubiera sido referida para atención altamente especializada que hubiese podido incrementar las probabilidades de supervivencia de ella y el neonato.

Abstract BACKGROUND Eisenmenger syndrome is congenital heart disease with a higher risk of mortality for pregnant women. CLINICAL CASE 21-years women with Eisenmenger syndrome, whose pregnancy was accompanied by class III NYHA heart failure and systemic arterial hypertension. Pregnancy was interrupted at 30 weeks by caesarean section. Six days after the caesarean section, the patient died due to cardiogenic shock. CONCLUSIONS The case described here allows us to reflect on the opportunities for improvement in the care of patients with Eisenmenger syndrome. At the first level of care, it is important to focus on specific education and counseling that allows the patient and her partner to understand the implicit risks of their condition, since the safest alternative would have been to avoid pregnancy. At the second level of care, the practice based on evidence and correct coordination in the health teams should always be favored, which in this particular case would have allowed the patient, since week 14, to have been referred for highly specialized care could increase the chances of survival of her and the neonate.

[Dengue with unusual clinical features in an infant: Case report]. / Dengue, presentación inusual en un lactante: Reporte de un caso.

The state of Yucatan, in Mexico, is an endemic area for dengue. During 2015, there was an unpredicted increase in the number of expected cases of dengue fever. OBJECTIVE: To describe and analyse the clinical presentation, progress, and management of a case of dengue infection with non-specific clinical manifestations in an infant which resulted in a dengue shock syndrome. CASE REPORT: One month old infant admitted to hospital with a generalised rash and a history of being bitten by an insect. He was diagnosed with anaphylaxis based on clinical manifestations and anamnesis. While in hospital, he developed hypotension, tachycardia, anaemia, and respiratory distress. He was transferred to the intensive care unit, but died on the fifth day. He tested positive to dengue virus in the PCR test and for IgG antibodies using Elisa. The basic cause of death was dengue shock syndrome. CONCLUSIONS: Dengue fever in young infant infections may be afebrile, so it is important to suspect them appropriately in the presence of a generalised rash, tachycardia, and hypotension, in order to avoid the deadly consequences of dengue shock.

Perfil clinicoepidemiológico de la infección por Chikungunya en casos hospitalarios atendidos en 2015 en Mérida, México / Clinical and epidemiological profile of chikungunya infection in hospital patients in 2015 in Mérida, Mexico / Perfil clínico-epidemiológico da infecção por chikungunya em casos hospitalares atendidos em 2015 em Mérida, México

Objetivos. Describir el perfil epidemiológico y analizar las manifestaciones clínicas por grupo de edad de los casos de chikungunya atendidos en 2015 en un hospital general de Mérida, México. Métodos. Estudio observacional en el cual se describen los casos de Chikungunya registrados por el Departamento de Vigilancia Epidemiológica entre julio y diciembre de 2015 y análisis de las manifestaciones clínicas por grupo de edad. La asociación entre los signos y síntomas y el ingreso hospitalario se analizó mediante un modelo de regresión logística. Resultados. En total se atendieron 830 casos diagnosticados de Chikungunya. La media de edad fue 27,4 ± 17,05 años y la razón de sexos, 1:1,4. Los casos procedieron en su mayoría del medio urbano (n = 592, 87%) y, en particular, de la ciudad capital. En 723 (90%) casos se notificó haber tenido contacto con el vector artrópodo en el peridomicilio. Las alteraciones musculares y articulares fueron más frecuentes en los grupos de mayor edad, mientras que el exantema lo fue entre los más jóvenes. Las manifestaciones de gravedad neurológicas y no neurológicas no tuvieron predominio por edad. Conclusiones. Los casos de Chikungunya atendidos fueron mayormente cuadros benignos autolimitados, mientras que las manifestaciones neurológicas como letargia, vómitos persistentes, hemorragia, fotofobia y cefalea intensa fueron predictores de la gravedad y su identificación oportuna en los menores de un año de edad fue posible mediante la vigilancia estrecha.

Objectives. Describe the epidemiological profile and analyze clinical manifestations by age group in chikungunya patients treated in 2015 in a Mérida, Mexico general hospital. Methods. An observational study describing chikungunya cases recorded by the Department of Epidemiological Surveillance from July to December 2015 and analyzing clinical manifestations by age group. A logistic regression model was used to analyze the association between signs and symptoms and hospital admission. Results. A total of 830 diagnosed chikungunya cases were treated. Average age was 27.4 ± 17.05 years and the male-to-female ratio was 1:1.4. Most patients came from urban areas (n = 592, 87%) and, in particular, the capital city. Contact with the arthropod vector in the peridomiciliary area was reported in 723 (90%) cases. Muscular and joint impairments were more frequent in the older groups, while rash was more frequent in younger groups. Neurological and non-neurological manifestations of severity did not show greater prevalence in any one age group. Conclusions. Chikungunya patients had primarily self-limited benign cases, while neurological manifestations such as lethargy, persistent vomiting, hemorrhage, photophobia, and intense headache were predictive of severity and their timely identification in children under 1 year of age was possible through close monitoring.

Objetivos. Descrever o perfil epidemiológico e analisar as manifestações clínicas por faixa etária dos casos de chikungunya atendidos em 2015 em um hospital geral de Mérida, México. Métodos. Estudo observacional em que são descritos os casos de chikungunya registrados pelo departamento de vigilância epidemiológica entre julho e dezembro de 2015 e é feita uma análise das manifestações clínicas por faixa etária. A associação entre os sinais e sintomas e a admissão hospitalar foi analisada em um modelo de regressão logística. Resultados. Ao todo, foram atendidos 830 casos diagnosticados de chikungunya. A idade média foi 27,4 ± 17,05 anos e a proporção entre os sexos foi de 1:1,4. Os casos foram procedentes na sua maioria da zona urbana (n = 592, 87%) e, em particular, da capital. Em 723 casos (90%) foi notificado o contato peridomiciliar com o vetor artrópode. Manifestações musculares e articulares foram mais frequentes nas faixas etárias avançadas, enquanto que o exantema foi mais comum em jovens. As manifestações neurológicas e não neurológicas graves não apresentaram predomínio por idade. Conclusões. Os casos de chikungunya atendidos foram na sua maioria quadros benignos autolimitados, enquanto que as manifestações neurológicas como letargia, vômitos persistentes, hemorragia, fotofobia e cefaleia intensa foram preditivas da gravidade da doença e a identificação oportuna em crianças menores de 1 ano foi possível com a vigilância rigorosa.

Modelling dengue fever risk in the State of Yucatan, Mexico using regional-scale satellite-derived sea surface temperature.

Accurately predicting vector-borne diseases, such as dengue fever, is essential for communities worldwide. Changes in environmental parameters such as precipitation, air temperature, and humidity are known to influence dengue fever dynamics. Furthermore, previous studies have shown how oceanographic variables, such as El Niño Southern Oscillation (ENSO)-related sea surface temperature from the Pacific Ocean, influences dengue fever in the Americas. However, literature is lacking on the use of regional-scale satellite-derived sea surface temperature (SST) to assess its relationship with dengue fever in coastal areas. Data on confirmed dengue cases, demographics, precipitation, and air temperature were collected. Incidence of weekly dengue cases was examined. Stepwise multiple regression analyses (AIC model selection) were used to assess which environmental variables best explained increased dengue incidence rates. SST, minimum air temperature, precipitation, and humidity substantially explained 42% of the observed variation (r2=0.42). Infectious diseases are characterized by the influence of past cases on current cases and results show that previous dengue cases alone explained 89% of the variation. Ordinary least-squares analyses showed a positive trend of 0.20±0.03°C in SST from 2006 to 2015. An important element of this study is to help develop strategic recommendations for public health officials in Mexico by providing a simple early warning capability for dengue incidence.

Dengue, presentación inusual en un lactante: reporte de un caso / Dengue with unusual clinical features in an infant: case report

El estado de Yucatán (México) es un área endémica para dengue. Durante el 2015 hubo un incremento en el número de casos esperados. OBJETIVO: Describir y analizar la presentación clínica, evolución y manejo de un caso de infección por dengue con manifestaciones clínicas inespecíficas en un lactante menor, que derivaron en síndrome de choque por dengue. CASO CLÍNICO: Lactante de un mes que consulta por eritema generalizado y antecedente de picadura de insecto. Su manejo hospitalario se basó en la resolución del episodio agudo de anafilaxia. Durante su estadía presentó hipotensión, taquicardia, anemia y dificultad respiratoria. Se derivó a terapia intensiva pediátrica, pero al quinto día de estancia falleció debido a síndrome de choque. La RPC y serología de anticuerpos IgG confirmaron etiología por dengue. CONCLUSIONES: Las infecciones por dengue en el lactante menor pueden cursar afebriles, por lo cual es importante sospecharlas oportunamente ante la presencia de eritema generalizado, taquicardia e hipotensión, con la finalidad de evitar las consecuencias letales del choque por dengue.

The state of Yucatan, in Mexico, is an endemic area for dengue. During 2015, there was an unpredicted increase in the number of expected cases of dengue fever. OBJECTIVE: To describe and analyse the clinical presentation, progress, and management of a case of dengue infection with non-specific clinical manifestations in an infant which resulted in a dengue shock syndrome. CASE REPORT: One month old infant admitted to hospital with a generalised rash and a history of being bitten by an insect. He was diagnosed with anaphylaxis based on clinical manifestations and anamnesis. While in hospital, he developed hypotension, tachycardia, anaemia, and respiratory distress. He was transferred to the intensive care unit, but died on the fifth day. He tested positive to dengue virus in the PCR test and for IgG antibodies using Elisa. The basic cause of death was dengue shock syndrome. CONCLUSIONS: Dengue fever in young infant infections may be afebrile, so it is important to suspect them appropriately in the presence of a generalised rash, tachycardia, and hypotension, in order to avoid the deadly consequences of dengue shock.

[Clinical and epidemiological profile of chikungunya infection in hospital patients in 2015 in Mérida, MexicoPerfil clÍnico-epidemiológico da infecção por chikungunya em casos hospitalares atendidos em 2015 em Mérida, México]. / Perfil clinicoepidemiológico de la infección por Chikungunya en casos hospitalarios atendidos en 2015 en Mérida, México.

OBJECTIVES: Describe the epidemiological profile and analyze clinical manifestations by age group in chikungunya patients treated in 2015 in a Mérida, Mexico general hospital. METHODS: An observational study describing chikungunya cases recorded by the Department of Epidemiological Surveillance from July to December 2015 and analyzing clinical manifestations by age group. A logistic regression model was used to analyze the association between signs and symptoms and hospital admission. RESULTS: A total of 830 diagnosed chikungunya cases were treated. Average age was 27.4 ± 17.05 years and the male-to-female ratio was 1:1.4. Most patients came from urban areas (n = 592, 87%) and, in particular, the capital city. Contact with the arthropod vector in the peridomiciliary area was reported in 723 (90%) cases. Muscular and joint impairments were more frequent in the older groups, while rash was more frequent in younger groups. Neurological and non-neurological manifestations of severity did not show greater prevalence in any one age group. CONCLUSIONS: Chikungunya patients had primarily self-limited benign cases, while neurological manifestations such as lethargy, persistent vomiting, hemorrhage, photophobia, and intense headache were predictive of severity and their timely identification in children under 1 year of age was possible through close monitoring.

OBJETIVOS: Descrever o perfil epidemiológico e analisar as manifestações clínicas por faixa etária dos casos de chikungunya atendidos em 2015 em um hospital geral de Mérida, México. MÉTODOS: Estudo observacional em que são descritos os casos de chikungunya registrados pelo departamento de vigilância epidemiológica entre julho e dezembro de 2015 e é feita uma análise das manifestações clínicas por faixa etária. A associação entre os sinais e sintomas e a admissão hospitalar foi analisada em um modelo de regressão logística. RESULTADOS: Ao todo, foram atendidos 830 casos diagnosticados de chikungunya. A idade média foi 27,4 ± 17,05 anos e a proporção entre os sexos foi de 1:1,4. Os casos foram procedentes na sua maioria da zona urbana (n = 592, 87%) e, em particular, da capital. Em 723 casos (90%) foi notificado o contato peridomiciliar com o vetor artrópode. Manifestações musculares e articulares foram mais frequentes nas faixas etárias avançadas, enquanto que o exantema foi mais comum em jovens. As manifestações neurológicas e não neurológicas graves não apresentaram predomínio por idade. CONCLUSÕES: Os casos de chikungunya atendidos foram na sua maioria quadros benignos autolimitados, enquanto que as manifestações neurológicas como letargia, vômitos persistentes, hemorragia, fotofobia e cefaleia intensa foram preditivas da gravidade da doença e a identificação oportuna em crianças menores de 1 ano foi possível com a vigilância rigorosa.

[Chagasic Cardiopathy in a child: Case report]. / Cardiopatía Chagásica en un escolar: Reporte de caso.

Chagas disease also known as American Trypanosomiasis is mainly caused by haematophagous insects widely distributed from Mexico to Argentina. According to the Panamerican Health Organization, 7.7 to 10 million people are living with chronic infection. Chagas disease is caused by Trypanosoma cruzi, a protozoan transmitted by triatomine vectors. After an initial acute phase, Chagas is followed by a silent phase that lasts 15-20 years before debuting with cardiac, neurological or gastrointestinal manifestations. OBJECTIVE: To analyze the atypical clinical course of chagasic cardiopathy in a pediatric patient from southern Mexico. CASE REPORT: The patient was treated by a chagoma in his left leg. Five months later an electrocardiogram showed evidence of sinus tachycardia and left atrium distension with P wave enlargement and prolonged QT interval. The thorax radiography showed cardiomegaly (Cardio-thoracic index = 0.52); the trans-thoracic echocardiogram showed left atrial and ventricular dilation. CONCLUSION: It is important to develop early cardiac evaluations even in pediatric patients with Chagas disease, it should not be assumed that the patients will undergo a long asymptomatic phase or that they will not develop an early cardiopathy.

Cardiopatía chagásica en un escolar: reporte de caso / Chagasic cardiopathy in a child: case report

La enfermedad de Chagas (ECh) o tripanosomiasis americana es una enfermedad transmitida principalmente por insectos hematófagos detectados en zonas rurales y urbanas desde México hasta Argentina. De acuerdo a la Organización Panamericana de la Salud, entre 7,7 y 10 millones de personas cursan con infección crónica. La ECh es causada por el protozoario flagelado Trypanosoma cruzi. Posterior al contacto inicial con el vector, la fase aguda es comúnmente seguida por una fase silente que dura 15-20 años antes de debutar con manifestaciones cardíacas, neurológicas o gastrointestinales. OBJETIVO: Analizar el curso clínico atípico de un caso de cardiopatía chagásica en un paciente pediátrico del sureste de México. CASO CLÍNICO: El paciente consultó al desarrollar un chagoma en la pierna izquierda. Cinco meses después, se observó en su electrocardiograma una taquicardia sinusal y un crecimiento auricular izquierdo con ondas P anchas e intervalo QT prolongado. En la radiografía de tórax se observó cardiomegalia (índice cardiotorácico = 0,52); en el ecocardiograma transtorácico mostró dilatación del atrio y ventrículo izquierdos. CONCLUSIÓN: Es importante realizar evaluaciones cardíacas oportunas en pacientes pediátricos con ECh, pues no debe asumirse que cursarán con una fase silente o que debutarán tardíamente con cardiopatía.

Chagas disease also known as American Trypanosomiasis is mainly caused by haematophagous insects widely distributed from Mexico to Argentina. According to the Panamerican Health Organization, 7.7 to 10 million people are living with chronic infection. Chagas disease is caused by Trypanosoma cruzi, a protozoan transmitted by triatomine vectors. After an initial acute phase, Chagas is followed by a silent phase that lasts 15-20 years before debuting with cardiac, neurological or gastrointestinal manifestations. OBJECTIVE: To analyze the atypical clinical course of chagasic cardiopathy in a pediatric patient from southern Mexico. CASE REPORT: The patient was treated by a chagoma in his left leg. Five months later an electrocardiogram showed evidence of sinus tachycardia and left atrium distension with P wave enlargement and prolonged QT interval. The thorax radiography showed cardiomegaly (Cardio-thoracic index = 0.52); the trans-thoracic echocardiogram showed left atrial and ventricular dilation. CONCLUSION: It is important to develop early cardiac evaluations even in pediatric patients with Chagas disease, it should not be assumed that the patients will undergo a long asymptomatic phase or that they will not develop an early cardiopathy.