Characteristics of common infections in Nicaragua

Abstract

The main purpose of the studies outlined in this thesis was to gain empirical epidemiological and therapeutic knowledge of some common infectious diseases in Nicaragua. So far, relatively little was known about the incidence, etiology, management and antibiotic resistance patterns of common infections. Of importance is to note that because of a lack of knowledge, currently many patients are unnecessarily treated with antibiotics for a presumed infection or the choice for the specific drug is untargeted. Such inefficient use of antibiotics may accelerate adverse drug reactions, increase costs, and most importantly contributes to the emerging problem of antibiotic resistance. The studies were therefore set up to provide tools to tackle common health problems effectively in the coming years. To provide the required knowledge, we conducted several prevalence studies in the source area of León, Nicaragua within the framework of the collaboration of the universities of León and Utrecht in close collaboration with epidemiologists, intensivists, medical microbiologist and infectious diseases specialists in the field. We focused on the common infections such as urinary tract infection and community acquired pneumonia (chapter 2, 3). In chapter 4 the adherence to a specifically developed protocol of antimicrobial prophylaxis before surgery was studied in a third prevalence study. In the final chapters (5, 6) we report on the prevalence of HIV and syphilis in pregnant women and the epidemiology of clinically apparent HIV infection in Nicaragua. Based on the results, we further elaborate on the recommended strategy to improve daily medical and preventive practice within the health system and the community.