Caso probable de tifus murino con falla ventilatoria en una adolescente del área urbana de Cali, Colombia

El tifus murino es una enfermedad infecciosa de caracter zoonotico causada por Rickettsia typhi . Se presenta el caso de una paciente femenina de 13 anos edad, procedente del area urbana de la ciudad de Cali, quien presento un cuadro febril asociado a taquipnea y exantema maculopapular generalizado en tronco y extremidades. Durante las primeras 48 h en la UCI pediatrica desarrollo rapido deterioro clinico, fiebre persistente, aumento de reactantes de fase aguda, presencia de infiltrados pulmonares intersticiales bilaterales y derrame pleural, requiriendo ventilacion mecanica no invasiva. Se inicio tratamiento con doxiciclina frente a la sospecha de una posible infeccion por agentes rickettsiales. Veinticuatro horas mas tarde la paciente presento mejoria clinica, resolucion del exantema y retiro de la ventilacion no invasiva. Por medio de la prueba de inmunofluorescencia indirecta se evidenciaron titulos de 1:512 frente al grupo del tifus, constatando el diagnostico probable de tifus murino.(AU) Murine typhus is a zoonotic infectious disease caused by Rickettsia typhi . We report a case of a 13-year old female patient from the urban area of the city of Cali, who presented with fever, associated with tachypnoea and generalised maculopapular exanthema on the trunk and limbs. During the first 48 h in the paediatric ICU, she rapidly deteriorated, with persistent fever, increased acute phase reactants, bilateral interstitial pulmonary infiltrates and pleural effusion requiring noninvasive ventilation. Treatment with doxycycline was initiated due to a suspected infection by rickettsial agents. Twenty-four hours later the patient presented clinical improvement and resolution of the exanthema, thus the non-invasive ventilation was withdrawn. By means of a indirect immunofluorescence test, titres of 1:512 were shown against the typhus group, leading to the probable diagnosis of murine typhus.(AU)