BACKGROUND AND OBJECTIVES: In September 2009, Metro Manila was hit by a heavy rainfall typhoon Ketsana inundating several cities of Metro Manila causing an outbreak of leptospirosis. We analyzed the prognostic factors associated with mortality among leptospirosis patients admitted after the typhoon at nine tertiary hospitals from September to November 2009.
METHODS: We reviewed the charts of patients with probable and confirmed leptospirosis. Confirmed leptospirosis was based on any of the following: positive leptospiral culture of blood or urine, single high leptospira microagglutination titer (MAT) of 1:1600 or a fourfold rise in MAT antibody titers or seroconversion. Patients with negative serology or cultures but with history of wading in floodwaters plus any of the following signs and symptons: fever, headache, myalgia, conjunctival suffusion, diarrhea and abdominal pain, jaundice, oliguria and changes in sensorium were considered probable cases.
RESULTS: We analyzed 332 probable and 259 confirmed leptospirosis patients. Mean age was 37.95± 14.09, mostly males (80.2%). Almost all patients (98%) waded in floodwaters. Majority had moderate to severe form of leptospirosis (83%). Acute renal failure was the most common complication (87.1%). Mortality was 11.3% mostly due to pulmonary hemorrhage. On multivariate analysis of confirmed and probable cases, the factors independently associated with mortality were pulmonary hemorrhage (OR 2.75, 95% CI 1.46 to 5.20), severity of the disease (OR 3.85, 95% CI 1.60 to 9.26), thrombocytopenia (OR 3.16, 95% CI 1.22-8.16), duration of illness before admission (OR 0.88, 95% CI 0.78-0.99) and age (OR 1.03, 95% CI 1.00-1.06).
CONCLUSION: Pulmonary hemorrhage remains a poor prognostic factor and strong predictor of mortality among patients with severe leptospirosis. Early consult through heightened awareness of the public and prompt recognition of leptospirosis among clinicians can decrease the risk for progression to complications of leptospirosis and mortality.

 

Human ; Male ; Female ; Adult ; Adolescent ; Hemorrhage ; Mortality ; Serology ; Abdominal Pain ; Acute Kidney Injury ; Cyclonic Storms ; Diarrhea ; Disease Outbreaks ; Fever ; Headache ; Jaundice ; Leptospira ; Leptospirosis ; Multivariate Analysis ; Myalgia ; Oliguria ; Philippines ; Prognosis ; Seroconversion ; Tertiary Care Centers ; Thrombocytopenia

BACKGROUND

Mpox, a zoonotic disease identified in central Africa in 1958, is mainly endemic to the Congo basin and West Africa. Collecting demographic and clinical data is crucial for early recognition and differentiation of skin lesions as the Philippines addresses this public health challenge.

OBJECTIVE

We describe the demographics, clinical profile, and outcomes of suspected and confirmed mpox cases in the Philippines from July to November 2022.

METHODS

This case series reviewed suspected and confirmed mpox cases at the Research Institute for Tropical Medicine from July to November 2022. Clinical data, demographics, and outcomes were collected through retrospective chart reviews and summarized using descriptive statistics.

RESULTS

Fifteen cases were reviewed, including 2 confirmed mpox cases, with an average age of 37.8 years and 80% male. The other symptoms associated with rash at presentation included fever (20%) followed by lymphadenopathy, malaise and chills reported in 1 case each. All patients had pustules and erythematous papules, with 67% showing vesicles. Lesions mainly appeared on the extremities (93%), trunk (60%), and head/neck (47%), evolving into crusts within 1–2 days. Non-confirmed cases were often misdiagnosed as varicella (60%), arthropod bites (20%), or folliculitis (7%).

DISCUSSION

Young to middle-aged males with travel histories were common in suspected and confirmed mpox cases. Lesions typically included papules and pustules on the extremities, evolving into crusts and erosions within 1–2 days. Confirmed cases had umbilicated papules and fever, while PCR-negative cases were diagnosed with local skin conditions. Testing is vital for timely detection and management, especially since mpox resembles other conditions.

Human ; Mpox, Monkeypox ; Zoonoses ; Zoonotic Disease

Introduction: In the 2016 National TB Prevalence Survey, the prevalence-to-notification ratio for smear-positive pulmonary tuberculosis was 3.1. In the TB registry, 94% of cases were reported by public providers, suggesting insufficient reporting from private physicians. This study describes the feasibility and acceptability of an electronic mobile device application for possible use among private physicians for reporting their TB cases. Methods: This interventional, pre-, and post-test study uses an electronic mobile device application to report TB cases. Using the application, physicians collected and uploaded specific information for reporting cases. The participants were duly-licensed physicians and board certified in any of the following: Internal Medicine, Adult Infectious Diseases, Adult Pulmonology, Pediatrics, Pediatric Infectious Diseases, or Pediatric Pulmonology. The participants used an electronic mobile device application for reporting TB cases. Feasibility and acceptability were assessed using a questionnaire and through a focus group discussion. Data were summarized with mean and standard deviation for continuous variables and proportions for categorical variables. Results: The study was conducted at the Research Institute for Tropical Medicine, a government hospital with a Tuberculosis Directly Observed Treatment Short-Course (TB DOTS) facility. Of the 30 physicians invited to participate, 24 provided consent, but only 15 downloaded the application (age range 34-61, mean 39 years, 11 females). Eleven of 15 physicians (73%) assessed the mobile application as easy to navigate and felt that information encoded was relevant to patient care. However, the internet connection affected the speed of the application. The physicians said they had no time, were too busy, or simply forgot to encode patient data. Conclusion The use of the application is acceptable but not feasible for use by private physicians. Modification to the application may be done to improve uptake by private physicians.
tuberculosis ; case reporting ; digital mobile device

BACKGROUND

Melioidosis is an infectious disease caused by Burkholderia pseudomallei. It is endemic in the Philippines and is underreported. Of the reported cases, the most common comorbidity is diabetes mellitus. The increasing cases of antibiotic resistance and the relatively high mortality rate highlights the need for increased awareness among clinicians regarding this disease. We aim to report a case of Burkholderia pseudomallei resistant to trimethoprim/sulfamethoxazole (TMP-SMX), used in its eradication following initial intravenous therapy.

CASE PRESENTATION

A 51-year-old male Filipino with poor health-seeking behavior came with generalized body weakness, weight loss, dysarthria, fever, cough, difficulty breathing, bloatedness, dysuria, joint pains, and bilateral lower extremity hyperpigmented macules for four months. He has diabetes mellitus and hypertension and is a mechanic by trade. Initial workups revealed hemoglobin A1c (HbA1c) of 14.7%, and urinalysis with bacteriuria. Imaging revealed bilateral pneumonia on chest xray, hepatosplenomegaly on whole abdomen ultrasound, and old cerebral infarcts on cranial computed tomography scan (CT scan). Empiric antibiotics for the impression of sepsis from community-acquired pneumonia and urinary tract infection were ertapenem and azithromycin. Upon isolation of Burkholderia pseudomallei from blood cultures, the team shifted to TMP-SMX and ceftazidime for initial therapy of melioidosis. Sensitivity showed resistance to TMP-SMX; hence the team revised the antimicrobials to four weeks of levofloxacin and ceftazidime. After eleven hospital days, the team sent the patient home, clinically improved. The team continued levofloxacin for eradication therapy for three months and the patient responded well.

CONCLUSION

Fever with multi-system involvement in a Filipino patient with diabetes mellitus with significant environmental risk factors, poor glycemic control, splenomegaly, and treatment failure with appropriate empiric antibiotic therapy should raise suspicion for melioidosis. It is paramount that antimicrobial resistance be detected and documented upon isolation of Burkholderia pseudomallei, given the high relapse rates and the need for a prolonged duration of treatment.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Melioidosis ; Philippines ; Diabetes Mellitus ; Burkholderia Pseudomallei