Severity of acute Zika virus infection: A prospective emergency room surveillance study during the 2015­2016 outbreak in Suriname

Acute Zika virus (ZIKV) infection is usually mild and self-limiting. Earlier, we reported three cases of fatal acute ZIKV infection in patients without typical signs of ZIKV, but rather with criteria of systemic inflammation response syndrome (SIRS). To follow up these observations, we prospectively included patients at the emergency room with temperature instability and suspected to have acute ZIKV infection, SIRS, or both. A total of 102 patients were included of whom N =21 (21%) were suspected of acute ZIKV infection, N =56 (55%) of acute ZIKV infection with SIRS criteria, and N =25 (24%) of SIRS alone. ZIKV-PCR was positive in N =21 (20%) patients. Eight (38%) ZIKV-positive patients needed admission to the hospital of whom four (50%) presented with SIRS alone. One ZIKV-positive patient had vascular co-morbidity and died following shock and severe coagulopathy. We confirm the hypothesis that acute ZIKV infection can present atypical and severely with systemic inflammation and have lethal course particularly amongst patients with significant prior disease...(AU)

Three atypical lethal cases associated with acute Zika virus infection in Suriname

Acute Zika virus infection usually presents with a self-limiting triad of fever, rash and arthritis. There is limited information on severe or lethal cases. We report three cases of lethal acute Zika infection, confirmed with polymerase chain reaction, in adult patients with some co-morbidities. The patients showed rapid clinical deterioration with hemorrhagic and septic shock, and exaggerated acute and innate inflammatory responses with pronounced coagulopathy, and died soon after admission to the hospital. It remains unclear whether the fatal outcomes were due to acute Zika virus infection alone or to the combination with exacerbated underlying prior disease or co-infection. Nonetheless, the severity of these cases implies that increased awareness for atypical presentations of Zika virus infection, and careful clinical assessment of patients with symptoms of Zika, is warranted during current and future outbreaks...(AU)

The economic impact of road traffic fatalities in Jamaica

OBJECTIVE: To estimate the economic cost of road traffic fatalities in Jamaica. DESIGN AND METHODS: This study used the Gross Output Approach to estimate the economic cost of road traffic fatalities in Jamaica for 2012 and 2013. It entailed estimating the cost of loss of output, cost of medical treatment, cost of damage to vehicles and other property and administrative cost. RESULTS: The fatalities per accident for 2012 and 2013 were 2.24 and 1.56 respectively. The average age of fatal accident victim is 39. With an average retirement age of 64, the average productive years lost is 26 years. Using an annual average wage of $1,021,488 in 2012 and $1,060,852 in 2013, the discounted loss of output per fatal crash in 2012 and 2013 is $42,131,733.1 and $30,472,454 respectively. CONCLUSION: Estimates from 2012 and 2013 suggested that loss of output alone from road traffic crashes accounted for $42,131,733.1 and $30,472,454 respectively.

An atypical aggressive Kaposi's sarcoma in a HIV-negative bisexual man

We describe a case of Kaposi's sarcoma in a previously healthy 35-year-old bisexual West Indian man of African descent who was seronegative for the human immunodeficiency virus (HIV) and human T-cell lymphotropic virus-1 (HTLV-1) and who presented with extensive mucocutaneous lesions, weight loss, visceral and generalized lymph node involvement, poor response to combination therapy with vinblastine and inter feron alfa-2a and a short survival of eight months from onset of illness. This is the first document case of Kaposi's sarcoma in Domonica. The presentation is unusal in that it is similar to the aggressive and disseminated Kaposi's sarcoma seen only in AIDS and florid variant of the endemic disease in young men in Equatorial Africa. (AU)

Severe pulmonary barotrauma

Pulmonary barotrauma is a well-known but rarely seen complication of mechanical intermittent positive pressure ventilation. It is thought to be related to raised pressures within alveoli which lead to their eventual rupture and the subsequent development of respiratory embarrassment. Mishaps related to faulty one-way valves in the self-inflating, bag-ventilation devices commonly used in cardiopulmonary resuscitation (CPR) can, although rarely, lead to severe barotrauma. In this report, we describe a case of pulmonary barotrauma that appeared to be related to the "locking" of the "Ambu" bag's one-way valve in the inspiratory position during routine CPR.(Au)

Tuberculous encephalopathy. A rare complication of pulmonary tuberculosis

A case of tuberculous encephalopathy, a rare form of neurotuberculosis, is reported in a 16-year-old girl who had pulmonary tuberculosis and extensive cerebral demyelination. The clinical, laboratory and pathological features of this entity are highlighted and the pathogenesis discussed.(Au)

Dengue haemorrhagic fever/dengue shock syndrome: an unwelcome arrival in Trinidad

This is the first report of dengue haemorrhagic fever and dengue shock syndrome in Trinidad. Dengue infection was confirmed serologically or by viral isolation in five patients, aged 15 to 33 years, who presented with fever, thrombocytopenia and haemoconcentration. Three patients developed dengue shock syndrome, which was fatal; although there was no haemorrhagic tendency among these patients, bleeding occurred shortly before death in one of them. Two patients who had dengue haemorrhagic fever survived. The co-circulation of dengue virus serotypes 1, 2 and 4 in the Caribbean facilitates the development of dengue shock syndrome (DSS) or dengue haemorrhagic fever (DHF). Clinicans should therefore be aware of their clinical features, laboratory diagnosis and clinical management. Appropriate public health interventions and improved surveillance should be implemented to reduce the risk of DHS/DSS associated mortality in Trinidad and Tobago.(AU)

Invasive streptococcal infections: report of four cases occurring in Trinidad

Many countries are reporting a resurgence of virulent streptococcal strains but there is little information from the Caribbean. Four cases of severe invasive streptococcal infections, three of them fatal, are reported. The portal of entry was infected scabatic lesions in one patient and infected mosquito bites in another patient who developed cellulitis and gangrene; but no portal of entry was detected in the other patients. Group A B haemolytic Streptococcus (GAS) was isolated from the blood of three patients, one of them GAS M type 3, which had the genome for streptococcal pyrogenic exotoxins A (SPeA)and B (SPeB). GAS M type 72, which had the genome for SPeB and SPeC, were isolated from the tissues (but not from the blood) of the patient who developed cellulitis and who was the sole survivor. Physicians in the Caribbean must be alerted to the presence of these virulent streptococcal strains, and must be prepared to manage serious invasive disease. (AU)

Maternal deaths associated with caesarean section

Twelve Caesarean section-associated maternal deaths were encountered over a 15-year period. The major operative risk factors were pregnancy-induced hypertension, obesity and general anaesthesia. Severe pre-eclampsia was the forerunner to postoperative cardiac failure, consumptive coagulopathy and difficult airway manipulation. We conclude that pregnancy-induced hypertension and its ramifications pose the greatest threat to maternal survival from Caesarean section. (AU)

Penicillin resistant streptococcus pneumoniae in a Jamaican patient with homozygous sickle cell disease

Penicillin prophylaxis against infection by Streptococcus pneumoniae is now routine in young children with homozygous sickle-cell (SS) disease and the emergence of penicillin-resistant strains is a serious clinical concern. The first death associated with such resistance in a Jamaican child with SS disease is reported (AU)

Multicentric angiofollicular lymph node hyperplasia in ulcerative colitis: a case report

Multicentric angiofollicular lymph node hyperplasia (MAFH) is a rare disorder which has been associated with various disease entities. This is the first report of its association with ulcerative colitis. details of lymph node histology and views on pathogenesis (AU)

Experience of human lymphotropic virus type 1 (HTLV-I) in an East London hospital

We describe the experience of The Royal London Hospital with human T-cell lymphotropic virus type 1 (HTLV-1 related disease. Twelve patients presented from 1988-1993, nine of them in 1993. None were born in the U.K. and 11 were of West Indian origin. Ten had overt lymphomas, one tropical spastic paraparesis/HTLV-1 associated myelopathy (TSP/HAM) and one typical lymphocytosis and strongyloidiasis. Five presented acutely ill to casualty and three died shortly after presentation. Four had been referred to rheumatologists and five had predominantly gastrointestinal symptoms. The population of Caribbean origin served by the hospital is 23,700 and one would only expect one or two cases of lymphoma and one or two of TSP/HAM per year. Overall the spectrum of clinical disease at presentation was varied. Suspicion of HTLV-1 infection is merited in patients of West Indian origin between the ages of 30 - 65 years, who present with a sarcoid-like illness, gastrointestinal symptoms, leukaemia/lymphoma, myelopathy or myositis like-illness. (AU)

Malignant triton tumour of the spine

A malignant triton tumour is a malignant schwannoma with rhabdomyoblastic differentiation, and is a very rare occurrence. We describe the case of a 33-year-old man with neurofibromatosis type 1 who presented with paraplegia. Pathological examination of an intradural, extramedullary tumour excised at lumbar laminectomy demonstrated a malignant schwannoma with rhabdomyoblastic differentiation. We believe this is the first documented case of a malignant triton tumour of the spine (AU)

Acute aphasia complicating typhoid fever in an adult

Motor aphasia complicating bacteriologically confirmed typhoid fever in a 20-year old adult female is presented. Neither the cause of death nor the aetiology of this isolated neurological deficit could be determined from detailed post-mortem examination. An immune related mechanism is suggested based on the temporal characteristics of this complication and CSF abnormalities.(AU)