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      Coinfección brucelosis-leptospirosis, Urabá, Colombia: Reporte de caso Translated title: Brucellosis leptospirosis co-infection: A case report

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          Abstract

          Se presenta un caso clínico de una confección de leptospirosis-brucelosis, en la región del Urabá antioqueño, en un paciente masculino de 45 años de edad con factores de riesgo ocupacionales, quien consultó inicialmente por síndrome febril prolongado y síntomas generales poco específicos además de manifestaciones hemorrágicas, lo que sumado a estar en área endémica, hizo sospechar el diagnóstico de leptospirosis, por lo cual se ordenó tratamiento, además de pruebas de laboratorio específicas. Luego de 45 días, el paciente consulta nuevamente con síndrome febril y orquiepididimitis unilateral, documentándose por pruebas de laboratorio el diagnóstico de brucelosis y leptospirosis, recibiendo tratamiento triconjugado (doxiciclina, rifampicina y gentamicina) con resolución de los síntomas. Este caso de coinfección obliga a tener presente la posibilidad de infecciones simultáneas en pacientes con síndromes febriles procedentes de áreas endémicas para zoonosis, particularmente en los más comprometidos clínicamente.

          Translated abstract

          A brucellosis leptospirosis co-infection case is presented in the Uraba Antioqueño region of Colombia. A 45-year old male with occupational risk factors initially sought medical advice complaining of high fever, unspecified symptoms and hemorrhagic manifestations. Due to the fact that the patient was in an endemic area, a diagnosis of leptospirosis was considered. Specific laboratory tests were ordered and treatment was initiated. Forty-five days later, the patient came back with fever and unilateral orchitis. A diagnosis of brucellosis and leptospirosis was documented with laboratory test results. He was treated with a triconjugate; doxycycline, rifampicine, and gentamicine, and a resolution of the symptoms was documented. This case reveals the importance of being aware of the possibility of a zoonosis co-infection in patients with febrile syndrome, especially in those with severe clinical symptoms.

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          Most cited references53

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          Brucellosis in Humans and Animals

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            Implications of laboratory diagnosis on brucellosis therapy.

            Brucellosis is a worldwide zoonosis with a huge economic impact on animal husbandry and public health. The diagnosis of human brucellosis can be protracted because the disease primarily presents as fever of unknown origin with unspecific clinical signs and symptoms. The isolation rate of the fastidious etiologic agent from blood cultures is low, and therefore laboratory diagnosis is mainly based on serologic and molecular testing. However, seronegative brucellosis patients have been described, and antibody titers of diagnostic significance are difficult to define. Whether the molecular detection of Brucella DNA in clinical samples should be followed by long-term antibiotic treatment or not is also a matter of debate. The aim of this article is to review and discuss the implications of laboratory test results in the diagnosis of human brucellosis on disease therapy.
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              Systematic Review and Meta-Analysis of Randomized Clinical Trials in the Treatment of Human Brucellosis

              Background Brucellosis is a persistent health problem in many developing countries throughout the world, and the search for simple and effective treatment continues to be of great importance. Methods and Findings A search was conducted in MEDLINE and in the Cochrane Central Register of Controlled Trials (CENTRAL). Clinical trials published from 1985 to present that assess different antimicrobial regimens in cases of documented acute uncomplicated human brucellosis were included. The primary outcomes were relapse, therapeutic failure, combined variable of relapse and therapeutic failure, and adverse effect rates. A meta-analysis with a fixed effect model was performed and odds ratio with 95% confidence intervals were calculated. A random effect model was used when significant heterogeneity between studies was verified. Comparison of combined doxycycline and rifampicin with a combination of doxycycline and streptomycin favors the latter regimen (OR = 3.17; CI95% = 2.05–4.91). There were no significant differences between combined doxycycline-streptomycin and combined doxycycline-gentamicin (OR = 1.89; CI95% = 0.81–4.39). Treatment with rifampicin and quinolones was similar to combined doxycycline-rifampicin (OR = 1.23; CI95% = 0.63–2.40). Only one study assessed triple therapy with aminoglycoside-doxycycline-rifampicin and only included patients with uncomplicated brucellosis. Thus this approach cannot be considered the therapy of choice until further studies have been performed. Combined doxycycline/co-trimoxazole or doxycycline monotherapy could represent a cost-effective alternative in certain patient groups, and further studies are needed in the future. Conclusions Although the preferred treatment in uncomplicated human brucellosis is doxycycline-aminoglycoside combination, other treatments based on oral regimens or monotherapy should not be rejected until they are better studied. Triple therapy should not be considered the current treatment of choice.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                inf
                Infectio
                Infect.
                Asociación Colombiana de Infectología. (Bogotá )
                0123-9392
                June 2014
                : 18
                : 2
                : 72-76
                Affiliations
                [1 ] Universidad CES Colombia
                [2 ] Universidad CES Colombia
                Article
                S0123-93922014000200006
                10.1016/j.infect.2014.02.002
                41e7fbef-2b6e-4b16-b907-c460c4330acf

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Colombia

                Self URI (journal page): http://www.scielo.org.co/scielo.php?script=sci_serial&pid=0123-9392&lng=en
                Categories
                INFECTIOUS DISEASES

                Infectious disease & Microbiology
                Brucellosis,Leptospirosis,Coinfection,Urabá,Colombia,Brucelosis,Coinfección

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