Objective. To determine the prevalence of leptospirosis in patients from Veracruz with initial diagnosis of dengue and its association with risk factors. Materials and Methods. Transversal study in patients who sought medical attention under the suspicion of dengue. Backgrounds were researched and blood samples were drawn to determine dengue (NS1, RT-PCR) and leptospirosis (IFI). Simple frequencies, central tendency and dispersion measures, and prevalence and trust intervals at 95% (IC95%) were obtained. Prevalence reasons (RP) and IC95% were obtained and a multivariate logistic model was applied, using SPSS？V15. Results. 171 patients were included, 56% women ( 3 2 ± 1 4 years) and 44% men ( 3 2 ± 1 7 years). 48% of the cases (IC95%？40.5–55.4) was positive to dengue, with a cut point of 1？:？80, seroprevalence for leptospirosis was of 6% (IC95%？2.7–10); 12% (IC95%？7–16.5) was positive to both pathologies and 34% was negative to both tests. Although the largest number of isolations corresponded to serotype 2, the four dengue virus serotypes were identified. In the bivariate analysis, overcrowding RP？=？1.33, (IC？=？0.46–3.5), bathing in rivers (RP？=？1.31, IC？=？0.13–7.4), and walking barefoot (RP？=？1.39, IC？=？0.58–3.3) were the variables associated with leptospirosis, although the relation was not statistically significant. Conclusions. Leptospirosis prevalence in subjects under suspicion of dengue fever is high, as well as the coincidence of both infections. The results show the coexistence of overlapped outbreaks of several diseases sharing the side of transmission. It is necessary the intentional search of other pathologies, such as influenza, rickettsiosis, and brucella, among others. 1. Introduction Dengue is a viral disease caused by any of the known dengue viruses (Den1–Den4), and it is transmitted by the bite of a previously infected female Aedes aegypti mosquito. Literature describes several presentations of the disease, which go from asymptomatic to undifferentiated forms, dengue fever, hemorrhagic dengue fever [1–3]. Currently there exists a clinical classification of the disease that considers the nonsevere dengue and severe dengue [4]. During the last decades, the number of cases of dengue has notably increased, as well as the countries affected worldwide [5, 6]. In America, the dissemination and permanence of the vector, as well as the circulation of the four serotypes, have favored conditions of extensive and repeated exposure to the population, which has been reflected in an increase of hemorrhagic forms [7–9]. In Mexico, this pathology has
References
[1]
Harrison, “Harrison. Principios de medicina interna,” in Infecciones Causadas por Virus Transmitidos por Artrópodos y Roedores, vol. 1, pp. 1296–1315, McGraw-Hill, 14th edition, 1998.
[2]
E. Martínez-Torres, “Dengue and hemorrhagic dengue: the clinical aspects,” Salud Pública De México, vol. 37, pp. S29–s44, 1995.
[3]
C. Ramos, H. García, and J. M. Villaseca, “Hemorrhagic fever and the dengue shock syndrome,” Salud Pública De México, vol. 35, no. 1, pp. 39–55, 1993.
[4]
Organización Mundial de la Salud. Organización Panamericana de la Salud. Dengue: Guías para el diagnóstico, tratamiento, prevención y control, 2009.
[5]
T. H. Jetten and D. A. Focks, “Potential changes in the distribution of dengue transmission under climate warming,” American Journal of Tropical Medicine and Hygiene, vol. 57, no. 3, pp. 285–297, 1997.
[6]
D. J. Gubler, “Dengue and dengue hemorrhagic fever,” Clinical Microbiology Reviews, vol. 11, no. 3, pp. 480–496, 1998.
[7]
G. G. Clark, “The epidemiological situation of dengue in america. the challenges for its surveillance and control,” Salud Pública De México, vol. 37, supplement, pp. S5–s11, 1995.
[8]
F. P. Pinheiro and S. J. Corber, “Global situation of dengue and dengue haemorrhagic fever, and its emergence in the americas,” World Health Statistics Quarterly, vol. 50, no. 3-4, pp. 161–169, 1997.
[9]
M. G. Guzman and G. Kouri, “Dengue and dengue hemorrhagic fever in the americas: lessons and challenges,” Journal of Clinical Virology, vol. 27, no. 1, pp. 1–13, 2003.
[10]
J. Narro Robles and H. Gómez Dantés, “El dengue en México: un problema prioritario de salud pública,” Salud Pública de México, vol. 37, supplement, pp. 12–20, 1995.
[11]
S. Ibá？ez-Bernal and H. Gómez-Dantés, “Vectors of dengue in mexico: a critical review,” Salud Pública De México, vol. 37, supplement, pp. S53–S63, 1995.
[12]
E. J. Navarrete, J. L. Vázquez, J. A. Vázquez, and H. Gómez, “Epidemiología del dengue y dengue hemorrágico en el instituto Mexicano del seguro social,” Revista Peruana de Epidemiología, vol. 7, no. 1, 2002.
[13]
E. Herrera-Basto, D. R. Prevots, M. L. Zarate, J. L. Silva, and J. Sepulveda-Amor, “First reported outbreak of classical dengue fever at 1,700 meters above sea level in Guerrero State, Mexico, June 1988,” American Journal of Tropical Medicine and Hygiene, vol. 46, no. 6, pp. 649–653, 1992.
[14]
Secretaría de Salud. Dirección General de Epidemiología. Boletines Epidemiológicos Anuales, 1985–2009.
[15]
P. N. Acha and B. Cifres, Zoonosis y Enfermedades Transmisibles Comunes al Hombre y a los Animales, Organización Panamericana de la Salud, Washington, DC, USA, 20th edition, 1992.
[16]
A. R. Bharti, J. E. Nally, J. N. Ricaldi et al., “Leptospirosis: a zoonotic disease of global importance,” Lancet Infectious Diseases, vol. 3, no. 12, pp. 757–771, 2003.
[17]
D. A. Ashford, R. M. Kaiser, R. A. Spiegel et al., “Asymptomatic infection and risk factors for leptospirosis in nicaragua,” American Journal of Tropical Medicine and Hygiene, vol. 63, no. 5-6, pp. 249–254, 2000.
[18]
O. Velasco-Castrejón, B. Rivas-Sánchez, and H. H. Rivera-Reyes, “Leptospirosis humana crónica,” in Diagnóstico y Tratamiento en la Práctica Médica, J. Narro-Robles, O. Rivero-Serrano, and J. J. López Bárcena, Eds., Manual Moderno, Hipódromo, Mexico, 3rd edition, 2008.
[19]
O. Velasco-Castrejón, B. Rivas-Sánchez, J. Espinoza, J. Jiménez, and E. Ruiz, “Mimic diseases accompanying leptospirosis,” Revista Cubana De Medicina Tropical, vol. 57, no. 1, pp. 75–76, 2005.
[20]
R. A. Hartskeerl, “International leptospirosis society: objectives and achievements,” Revista Cubana De Medicina Tropical, vol. 57, no. 1, pp. 7–10, 2005.
[21]
G. D. Gavaldón, A. M. Cisneros, N. Rojas, and L. P. Moles-Cervantes, “Importancia de la Leptospirosis Humana en México. Detección de Anticuerpos Antileptospira en una población de donadores de sangre,” Gaceta Médica de México, vol. 131, no. 3, pp. 289–292, 1995.
[22]
C. B. Leal-Castellanos, R. Garcia-Suárez, E. Gonzalez-Figueroa, J. L. Fuentes-Allen, and J. Escobedo-De la Pe？a, “Risk factors and the prevalence of leptospirosis infection in a rural community of Chiapas, México,” Epidemiology and Infection, vol. 131, no. 3, pp. 1149–1156, 2003.
[23]
E. J. Navarrete, J. A. Acevedo, H. E. Huerta, B. J. Torres, and R. D. Gavaldón, “Prevalencia de anticuerpos contra dengue y leptospira en la población de Jáltipan, Veracruz,” Salud Pública de México, vol. 48, pp. 220–228, 2006.
[24]
J. Navarrete Espinosa, M. Moreno Mu？oz, B. Rivas Sánchez, and O. Velasco Castrejón, “Leptospirosis prevalence in a population of Yucatan, Mexico,” Journal of Pathogens, vol. 2011, Article ID 408604, 5 pages, 2011.
[25]
M. G. Guzmán, G. Kourí, and J. L. Pelegrino, “Emerging viral diseases,” Revista Cubana De Medicina Tropical, vol. 53, no. 1, pp. 5–15, 2001.
[26]
C. M. Leptospirosis, “Enfermedad zoonótica reemergente,” Revista Peruana de Medicina Experimental y Salud Pública, vol. 23, no. 1, pp. 5–11, 2006.
[27]
J. Navarrete and H. Gómez, “Arbovirus causales de fiebre hemorrágica en pacientes del Instituto Mexicano del Seguro Social,” Revista Medica del Instituto Mexicano del Seguro Social, vol. 44, no. 4, pp. 347–353, 2006.
[28]
J. E. Zavala-Velázquez, I. A. Vado-Solís, M. E. Rodríguez-Félix, et al., “Leptospirosis anictérica en un brote epidémico de dengue en la Península de Yucatán,” Review of Biomedical, vol. 9, pp. 78–83, 1998.
[29]
E. J. Sanders, J. G. Rigau-Pérez, H. L. Smits et al., “Increase of leptospirosis in dengue-negative patients after a hurricane in Puerto Rico in 1966,” American Journal of Tropical Medicine and Hygiene, vol. 61, no. 3, pp. 399–404, 1999.
[30]
Boletines Epidemiológicos, Coordinación de Vigilancia Epidemiológica y Apoyo en Contingencias, Unidad de Salud Pública, IMSS, 2005–2010.
[31]
A. Chuansumrit, W. Chaiyaratana, V. Pongthanapisith, K. Tangnararatchakit, S. Lertwongrath, and S. Yoksan, “The use of dengue nonstructural protein 1 antigen for the early diagnosis during the febrile stage in patients with dengue infection,” Pediatric Infectious Disease Journal, vol. 27, no. 1, pp. 43–48, 2008.
[32]
J. Mota, M. Acosta, R. Argotte, R. Figueroa, A. Méndez, and C. Ramos, “Induction of protective antibodies against dengue virus by tetravalent dna immunization of mice with domain iii of the envelope protein,” Vaccine, vol. 23, no. 26, pp. 3469–3476, 2005.
[33]
OMS. ILS: Human Leptospirosis: Guidence for Diagnosis, Surveillence and Control, 2003.
[34]
O. Velasco, B. Rivas, and A. Becker, “Vecovisión, un nuevo método imagenológico para el diagnóstico definitivo de leptospirosis,” Revista Cubana de Medicina Tropical, vol. 54, no. 1, article 67, 2002.
[35]
A. Schiaffino, M. Rodríguez, M. I. Pasarín, E. Regidor, C. Y. Borrell, and E. Fernández, “Odds ratio o razón de proporciones? Su utilización en estudios transversales,” Gaceta Sanitaria, vol. 17, no. 1, pp. 70–74, 2003.
[36]
J. Pradutkanchana, S. Pradutkanchana, M. Kemapanmanus, N. Wuthipum, and K. Silpapojakul, “The etiology of acute pyrexia of unknown origin in children after a flood,” Southeast Asian Journal of Tropical Medicine and Public Health, vol. 34, no. 1, pp. 175–178, 2003.
[37]
M. G. Bruce, E. J. Sanders, J. A. D. Leake et al., “Leptospirosis among patients presenting with dengue-like illness in Puerto Rico,” Acta Tropica, vol. 96, no. 1, pp. 36–46, 2005.
[38]
V. M. dos Santos, J. A. dos Santos, T. A. Sugai, and L. A. dos Santos, “Weil's syndrome,” Revista Cubana De Medicina Tropical, vol. 55, no. 1, pp. 44–46, 2003.
