Immune thrombocytopenia (ITP) is an autoimmune hematological condition characterized by a markedly isolated decrease in platelets without any apparent associated clinical conditions, resulting in bleeding and bruising of the skin, mucous membranes, and major organs. It is often triggered by preceding illness or several immune stimulants such as immunizations, infections, allergic reactions, among others. While uncommon, arthropod bites can trigger acute ITP. Four cases have been reported due to bee stings and insect bites, as well as a case of ITP following honeybee-venom therapy. Here, we report a case of acute ITP possibly triggered by multiple tick bites.

Yellow fever remains a major public health threat in endemic and re-emerging regions of Africa and South America, with recent outbreaks highlighting persistent gaps in prevention and surveillance. Pregnant women represent a particularly vulnerable population, yet the epidemiology, clinical impact, and preventive strategies for yellow fever in pregnancy are insufficiently characterized. Physiological and immunological changes during gestation may influence host responses to infection; however, current evidence does not demonstrate increased susceptibility to or severity of yellow fever during pregnancy. Adverse materno-fetal outcomes, including miscarriage, stillbirth, preterm birth, and, in rare cases, perinatal transmission, have been reported but remain poorly characterized. Diagnostic challenges, overlapping clinical presentations with other arboviral and hepatic diseases, and limited access to specialized care further complicate clinical management in many endemic settings. This perspective provides a comprehensive overview of yellow fever in pregnancy during the 2024–2026 outbreak in the Americas, including a risk-stratification framework for prevention. We summarize current evidence on epidemiology, pathophysiology, diagnosis, and supportive care, and examine prevention strategies with particular emphasis on vaccination. Accumulated observational evidence and substantial real-world experience have not demonstrated an increased risk of serious adverse events and generally support the effectiveness of yellow fever vaccination during pregnancy when administered with appropriate clinical judgment. In high-risk settings, the benefits of maternal immunization clearly outweigh theoretical concerns, supporting a flexible, risk-based approach, despite relatively limited evidence. We also discuss national and international policies, post-pregnancy booster recommendations, and the importance of integrating vaccination assessment into antenatal care. Finally, we highlight critical knowledge gaps and research priorities, including the need for prospective registries and strengthened pharmacovigilance. Coordinated clinical and public health strategies are essential to protect maternal and neonatal health and to reduce the burden of yellow fever in endemic and re-emerging settings.

Introducción: El manejo de personas que viven con VIH ha experimentado avances significativos en las últimas décadas con el tratamiento antirretroviral (TAR); sin embargo, los profesionales de la salud continúan enfrentando desafíos en el manejo clínico, particularmente en lo que respecta a la interpretación de la carga viral y la toma de decisiones terapéuticas. El objetivo de este estudio fue unificar definiciones y directrices para la interpretación y manejo de las viremias de bajo nivel persistentes en personas con VIH que reciben terapia antirretroviral en Colombia. Materiales y métodos: Revisión sistemática de la literatura en torno a cuatro preguntas clínicas. La evidencia se clasificó según los niveles del Oxford Centre for Evidence-Based Medicine (2009). Se empleó un consenso Delphi modificado con expertos nacionales. El umbral de consenso fuerte se definió como el acuerdo de al menos el 80% de los expertos participantes. Resultados: Se revisaron dieciocho documentos relevantes. Se desarrollaron doce recomendaciones con consenso fuerte, enfocadas en la definición de viremias de bajo nivel persistente, el uso dirigido de genotipificación a partir de 200 copias/mL y la transición a esquemas de alta barrera genética. Discusión: Estudios recientes sugieren que la viremia de bajo nivel persistentemente detectable puede aumentar el riesgo de resistencia emergente y de fracaso virológico. Este documento adopta un enfoque más conservador y clínico, en línea con las recomendaciones del DHHS y de GeSIDA. Se enfatiza la importancia de evaluar la adherencia, optimizar los esquemas y usar la genotipificación de manera juiciosa. En conclusión, la evaluación cuidadosa de la adherencia, la utilización de esquemas de alta barrera genética y un enfoque individualizado permiten optimizar la atención de las personas con VIH con viremias de bajo nivel persistentes, especialmente en escenarios clínicos de incertidumbre.

Yellow fever remains a major public health threat in endemic and re-emerging regions of Africa and South America, with recent outbreaks highlighting persistent gaps in prevention and surveillance. Pregnant women represent a particularly vulnerable population, yet the epidemiology, clinical impact, and preventive strategies for yellow fever in pregnancy are insufficiently characterized. Physiological and immunological changes during gestation may increase susceptibility to severe disease and contribute to adverse maternal and fetal outcomes, including miscarriage, stillbirth, preterm birth, and, in rare cases, perinatal transmission. Diagnostic challenges, overlapping clinical presentations with other arboviral and hepatic diseases, and limited access to specialized care further complicate clinical management in many endemic settings. This perspective provides a comprehensive overview of yellow fever in pregnancy during the 2024–2026 outbreak in the Americas, including a risk-stratification framework for prevention. We summarize current evidence on epidemiology, pathophysiology, diagnosis, and supportive care, and examine prevention strategies with particular emphasis on vaccination. Accumulated observational evidence and substantial real-world experience have not demonstrated an increased risk of serious adverse events and generally support the effectiveness of yellow fever vaccination during pregnancy when administered with appropriate clinical judgment. In high-risk settings, the benefits of maternal immunization clearly outweigh theoretical concerns, supporting a flexible, risk-based approach, despite relatively limited evidence. We also discuss national and international policies, post-pregnancy booster recommendations, and the importance of integrating vaccination assessment into antenatal care. Finally, we highlight critical knowledge gaps and research priorities, including the need for prospective registries and strengthened pharmacovigilance. Coordinated clinical and public health strategies are essential to protect maternal and neonatal health and to reduce the burden of yellow fever in endemic and re-emerging settings.