ABSTRACT
El Eritema Multiforme (EM) es una reacción cutánea aguda generalmente benigna y autolimitada, asociada a la infección por Virus Herpes Simplex (HSV). Se caracteriza por lesiones polimorfas y tipo diana en extremidades y mucosas. Presentamos un paciente de 22 años con pápulas, vesículas y ampollas, que evoluciona con un 90% de la superficie corporal comprometida en tres semanas. Se realizó una reacción de polimerasa en cadena para HSV, resultando positiva en una costra. La biopsia de piel y la tinción de inmunohistoquímica positiva para linfocitos T CD4, fueron compatibles con EM ampollar asociado a HSV. Destacamos la importancia de la correlación clínico patológica, apoyada por el estudio virológico, en el diagnóstico de este caso de presentación atípica. Los hallazgos de laboratorio confirmaron lo descrito en la literatura respecto de la patogenia del EM asociado a HSV.
Erythema Multiforme (EM) is a generally benign and self-limited acute cutaneous reaction, associated with Herpes Simplex Virus (HSV) infection. It is characterized by polymorphic "target" lesions in extremities and mucosal tissues. We report a 22-year old patient with papules, vesicles and blisters, which evolved to cover 90% of the body in three weeks. We performed a PCR study for HSV, which was positive in a crust. A skin biopsy and positive immunohistochemical stain for LT CD4+ were compatible with bullous EM associated with HSV. We underline the importance of pathological clinical correlation, reinforced by a virological study, in the diagnosis of this case with atypical symptoms. The laboratory findings confirmed literature descriptions with respect to the pathogenicity of EM associated with HSV.
ABSTRACT
BACKGROUND: There is evidence to postulate that undernotification is the reason for the great decrease in the reported incidence of hydatidosis in Chile. AIM: To develop and propose a method to assess the notification of transmissible diseases, based on observed lethality and hospital discharges. MATERIAL AND METHODS: Human hydatidosis in the period 1985-1994 was used as a model to develop the method. Official reports and mortality were analyzed first, determining the first lethality rate. A second lethality rate was calculated based on hospital discharges and a third, based on all Chilean surgical series published in the last two decades. Adjusting official notification of lethality to the true lethality according to surgical series, the number of unreported cases was calculated and the true incidence of hydatidosis was calculated, summing these cases to the official notification. RESULTS: According to this method, the real rates of human hydatidosis in the period 1985-1994, would fluctuate between 6.5 and 11.4 per 100,000. This figure is four times higher than the official notification in the analysed period. CONCLUSIONS: The correction of under notification based on hospital discharges, with or without correction for repeated hospital admissions, or real mortality of surgical series gave similar results, suggesting that both methods are correct.