RESUMO
A nosocomial outbreak of disease involving 5 patients, 4 of whom died, occurred in South Africa during September-October 2008. The first patient had been transferred from Zambia to South Africa for medical management. Three cases involved secondary spread of infection from the first patient, and 1 was a tertiary infection. A novel arenavirus was identified. The source of the first patient's infection remains undetermined.
Assuntos
Infecções por Arenaviridae/epidemiologia , Arenavirus/genética , Infecção Hospitalar/epidemiologia , Febres Hemorrágicas Virais/epidemiologia , Febres Hemorrágicas Virais/virologia , Adulto , Antivirais/uso terapêutico , Arenavirus/classificação , Busca de Comunicante , Surtos de Doenças , Evolução Fatal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ribavirina/uso terapêutico , Zâmbia/epidemiologiaAssuntos
Antivirais/economia , Antivirais/uso terapêutico , Infecções por Arenaviridae/tratamento farmacológico , Ribavirina/economia , Ribavirina/uso terapêutico , Infecções por Arenaviridae/epidemiologia , Infecções por Arenaviridae/fisiopatologia , Surtos de Doenças/economia , Custos de Medicamentos , Feminino , Humanos , Masculino , África do Sul/epidemiologiaRESUMO
Invasive pneumococcal infection (IPI) is a re-emerging complication of Streptococcus pneumoniae infection, particularly in patients with human immunodeficiency virus (HIV) infection. We report a case of a patient who presented with pneumococcal septicaemia, meningitis and septic arthritis, which initially responded to antibiotics, but where the patient eventually succumbed to infective endocarditis of the tricuspid valve. We discuss the spectrum of clinical manifestations of IPI, focusing especially on the Austrian syndrome (defined as pneumococcal endocarditis with rupture of the aortic valve and meningitis), its association with HIV infection, and its management in light of the emergence of penicillin-resistant strains of Streptococcus pneumonia.
Assuntos
Artrite Infecciosa/microbiologia , Endocardite/microbiologia , Infecções por HIV/complicações , Infecções Pneumocócicas/complicações , Valva Tricúspide/microbiologia , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: In 2008 a nosocomial outbreak of five cases of viral hemorrhagic fever due to a novel arenavirus, Lujo virus, occurred in Johannesburg, South Africa. Lujo virus is only the second pathogenic arenavirus, after Lassa virus, to be recognized in Africa and the first in over 40 years. Because of the remote, resource-poor, and often politically unstable regions where Lassa fever and other viral hemorrhagic fevers typically occur, there have been few opportunities to undertake in-depth study of their clinical manifestations, transmission dynamics, pathogenesis, or response to treatment options typically available in industrialized countries. METHODS AND FINDINGS: We describe the clinical features of five cases of Lujo hemorrhagic fever and summarize their clinical management, as well as providing additional epidemiologic detail regarding the 2008 outbreak. Illness typically began with the abrupt onset of fever, malaise, headache, and myalgias followed successively by sore throat, chest pain, gastrointestinal symptoms, rash, minor hemorrhage, subconjunctival injection, and neck and facial swelling over the first week of illness. No major hemorrhage was noted. Neurological signs were sometimes seen in the late stages. Shock and multi-organ system failure, often with evidence of disseminated intravascular coagulopathy, ensued in the second week, with death in four of the five cases. Distinctive treatment components of the one surviving patient included rapid commencement of the antiviral drug ribavirin and administration of HMG-CoA reductase inhibitors (statins), N-acetylcysteine, and recombinant factor VIIa. CONCLUSIONS: Lujo virus causes a clinical syndrome remarkably similar to Lassa fever. Considering the high case-fatality and significant logistical impediments to controlled treatment efficacy trials for viral hemorrhagic fever, it is both logical and ethical to explore the use of the various compounds used in the treatment of the surviving case reported here in future outbreaks. Clinical observations should be systematically recorded to facilitate objective evaluation of treatment efficacy. Due to the risk of secondary transmission, viral hemorrhagic fever precautions should be implemented for all cases of Lujo virus infection, with specialized precautions to protect against aerosols when performing enhanced-risk procedures such as endotracheal intubation.