The potential use of arginine kinase from the brown tick Rhipicephalus sanguineus as a biomarker for vector exposure in the surveillance of Rocky Mountain spotted fever.

The brown dog tick (Rhipicephalus sanguineus) is the vector of Rickettsia rickettsii, the causative agent of Rocky Mountain spotted fever (RMSF) in Northern Mexico and Southwestern United States. The immune response to a tick protein in the sera of humans or animals may reveal the zones with a high propensity to acquire RMSF, and vector control strategies may be focused on these zones. Arginine kinase (AK) is a highly antigenic invertebrate protein that may serve as a marker for tick exposure. We used R. sanguineus recombinant AK in an indirect ELISA assay with RMSF-positive patient sera. The response to AK was significantly higher against the sera of RMSF patients than the control sera from healthy participants without contact with dogs. To validate the antigenicity of tick AK, we mutated one predicted conformational epitope to alanine residues, which reduced the recognition by RMSF patients' immunoglobulins. This preliminary result opens a perspective towards the development of a complimentary technique based on RsAK as an antigen biomarker for vector serological surveillance for Rickettsia RMSF prevention.

[First autochthonous case of spotted fever associated with the Reserva Ecológica Costanera Sur, Buenos Aires City]. / Primer caso autóctono de fiebre manchada asociado a la Reserva Ecológica Costanera Sur, Ciudad Autónoma de Buenos Aires.

The first autochthonous case of rickettsiosis is reported here. The case occurred in the Costanera Sur Ecological Reserve, a protected area of the City of Buenos Aires, in August 2022, where 4 species of ticks were found, namely Amblyomma aureolatum, Ixodes auritulus sensu lato, Rhipicephalus sanguineus sensu stricto and Amblyomma triste. The epidemiological, ecological, clinical and laboratory aspects that allowed timely diagnosis and appropriate treatment are also described.

How do gene mutation diversity and disease severity scoring affect physical capacity and quality of life in children/adolescents with Familial Mediterranean Fever?

OBJECTIVES: The aim of this study is to examine how gene mutation diversity and disease severity affect physical capacity and quality of life in children/adolescents with Familial Mediterranean Fever (FMF). METHODS: Eighty children/adolescents (42 female, 38 male) diagnosed with FMF according to Tell-Hashomer diagnostic criteria were included in this study. Disease severity score (PRAS), running speed and agility and strength subtests of Bruininks-Oseretsky Test of Motor Proficiency Second Edition Short Form (BOT-2 SF), Physical Activity Questionnaire, Pediatric Quality of Life Inventory 3.0 Arthritis Module (PedsQL) was used for evaluation. Participants were divided into 2 groups as M694V and other mutations according to MEFV gene mutation and were divided into 3 groups as mild, moderate and severe according to PRAS. RESULTS: When the data were compared between groups; in terms of gene mutation, a significant difference was observed in treatment subtest of PedsQL-parent form in favor of the M694V gene mutation group (p<0.05). In terms of PRAS, significant difference was seen in the pain, treatment subtests and total score of the PedsQL-child form, and in the pain, treatment, worry subtests and total score of the PedsQL-parent form in favor of the mild group (p<0.05). CONCLUSIONS: MEFV gene mutations in children and adolescents with FMF did not differ on physical capacity and quality of life. PRAS was not effective on physical parameters, but quality of life decreased as the severity score increased. Encouraging children/adolescents with FMF to participate in physical activity and to support them psychosocially can be important to improve their quality of life.

Etiological spectrum and diagnostic challenges of short-duration fever in West Bengal (India). A cross-sectional tertiary care study.

INTRODUCTION: The scarcity of epidemiological data on acute febrile illnesses from South Asia impairs evidence-based clinical decision-making. Our study aimed to explore the etiological spectrum of short-duration fever in patients admitted to a tertiary care hospital in West Bengal, India. METHODS: We conducted a cross-sectional study from May 2021 to April 2022 involving 150 adult patients presenting with a fever lasting less than two weeks at Burdwan Medical College and Hospital (West Bengal, India). We performed comprehensive clinical assessments, including microbiological, serological, and other specific investigations, to identify the causes of the fever. RESULTS: The demographic profile predominantly included individuals aged 21-40 years, with a male-to-female ratio of 1.9:1; 60.7% of participants were from rural areas. The primary etiological agents identified were scrub typhus (25.3%), dengue (15.3%), and enteric fever (13.3%). Notably, 80% of patients presented with non-localizing symptoms, while 14.7% had respiratory symptoms. Blood cultures pinpointed Salmonella typhi and Staphylococcus aureus in a minority of cases (3.3%); malaria, primarily Plasmodium vivax, was diagnosed in 12% of the cases. CONCLUSION: Our findings highlight the complexity of diagnosing short-duration fevers, dominated by a wide range of etiological agents, with a notable prevalence of scrub typhus. These results underscore the urgent need for enhanced diagnostic facilities, including the availability of scrub typhus testing at primary healthcare centers. We recommend empirical doxycycline therapy for suspected cases and emphasize the need for further research to develop management guidelines for acute febrile illnesses. This study also highlights the importance of raising both community and clinician awareness to prevent irrational antibiotic use.

[Syndromic approach in migrant patients: Fever, diarrhea, anemia, eosinophilia and chronic cough]. / Abordaje sindrómico en el paciente inmigrante: fiebre, diarrea, anemia, eosinofilia y tos crónica.

Migrant patients share the same diseases as natives, but biological or environmental differences may lead to distinct prevalence and manifestations of certain syndromes. Some common conditions in Primary Care stand out, such as fever, diarrhea, anemia, eosinophilia, and chronic cough, where it is important to have a special consideration. Fever may indicate a serious imported illness, and malaria should always be ruled out. Diarrhea is generally of infectious origin, and in most cases, management is outpatient. Anemia may indicate malnutrition or malabsorption, while eosinophilia may indicate a parasitic infection. Lastly, chronic cough may be a sign of tuberculosis, especially in immigrants from endemic areas. Family medicine holds a privileged position for the comprehensive, culturally sensitive, and person-centered approach to these conditions.

Dengue en paciente de 32 días de vida. Reporte de un caso poco habitual / Dengue fever in a 32-day-old patient. A rare case report

El dengue es una enfermedad viral transmitida por la picadura del mosquito Aedes aegypti. El comportamiento del dengue en Argentina es epidémico; la mayoría de los casos se observan en los meses de mayor temperatura. Hasta la semana epidemiológica (SE) 20/2023, se registraron en Argentina 106 672 casos; se vieron afectadas 18 de las 24 provincias que conforman el país. Dentro de los principales grupos de riesgo, se incluyen los menores de 2 años. Reconocer los signos, síntomas e identificar los factores de riesgo es fundamental para el manejo de casos con mayor riesgo de gravedad. Presentamos el caso de una paciente de 32 días de vida que se internó por síndrome febril sin foco, con diagnósticos diferenciales de meningitis viral y sepsis, evolucionó con leucocitosis, plaquetopenia, hipoalbuminemia, asociado a exantema y edemas. Se llegó al diagnóstico de dengue por la clínica, epidemiologia e IgM positiva.

Dengue fever is a viral disease transmitted by the Aedes aegypti mosquitoes. In Argentina, dengue fever is an epidemic disease; most cases are reported during the hot months.Until epidemiological week (EW) 20/2023, 106 672 cases were reported across 18 of the 24 provinces of Argentina. Children younger than 2 years are among the main groups at risk. Recognizing signs and symptoms and identifying risk factors is fundamental for the management of cases at a higher risk of severity. Here we describe the case of a 32-day-old female patient who was hospitalized due to febrile syndrome without a source, who had a differential diagnosis of viral meningitis and sepsis and progressed to leukocytosis, thrombocytopenia, hypoalbuminemia in association with rash and edema. The diagnosis of dengue fever was established based on clinical, epidemiological, and positive IgM data.

Validez de herramientas diagnósticas en pacientes pediátricos hospitalizados con diagnóstico presuntivo de dengue en un Hospital de Referencia de Paraguay / Validity of diagnostic tools in pediatric patients hospitalized with a presumptive diagnosis of dengue in a Reference Hospital in Paraguay

Introducción: El dengue es la enfermedad arboviral más común en los seres humanos. Un diagnóstico temprano y preciso del dengue puede respaldar el manejo clínico, la vigilancia y el control de la enfermedad y es fundamental, por ello en el diagnóstico del dengue es importante contar con pautas clínicas y epidemiológicas que permitan la identificación oportuna y una conducta terapéutica adecuada. Objetivos: Evaluar la validez de herramientas diagnósticas en pacientes pediátricos hospitalizados con diagnóstico presuntivo de dengue en un Hospital de Referencia de Paraguay durante los años de 2012 a 2020. Materiales y métodos: Estudio analítico de tipo observacional, retrospectivo correspondientes a pacientes pediátricos (0 a 18 años) internados en el Hospital de Referencia de Paraguay el periodo enero 2012 a julio 2020 con diagnostico presuntivo de dengue al ingreso. Se realizó́ un análisis bivariado relacionando las frecuencias de 20 grupos de criterios diagnósticos combinados y 3 criterios diagnósticos aislados (OMS 2009, nexo epidemiológico y antigenemia NS1 para dengue) con el gold standard de diagnóstico que fue la conversión serológica. Resultados: Participaron del estudio 342 sujetos. EL 44% tenía edad escolar y 70% tenía 5 años o más. El 52,76% (191) fueron masculinos. Se encontraron desnutrición y sobrepeso en el 13% y 2%, respectivamente. La combinación de proteína C reactiva con plaquetopenia se encontró́ en 0.45% de los pacientes sin dengue y en el 6% de los pacientes con diagnóstico final de dengue (p=0.004). Conclusión: Este resultado aporta la alternativa de uso de una combinación sencilla de exámenes de laboratorio que puede replicarse en salas de urgencias como en salas de internación en un primer contacto con pacientes febriles con sospecha de fiebre dengue.

Introduction: Dengue is the most common arboviral disease in humans. An early and accurate diagnosis of dengue can support the clinical management, surveillance and control of the disease and is essential, therefore in the diagnosis of dengue it is important to have clinical and epidemiological guidelines that allow timely identification and appropriate therapeutic conduct. Objectives: To evaluate the validity of diagnostic tools in pediatric patients hospitalized with a presumptive diagnosis of dengue in a Reference Hospital in Paraguay during the years 2012 to 2020. Materials and methods: Analytical study of case and control type, observational, longitudinal, retrospective corresponding to pediatric patients (0 to 18 years) admitted to the Reference Hospital of Paraguay from January 2012 to July 2020 with a presumptive diagnosis of dengue at income. A bivariate analysis was performed relating the frequencies of 20 groups of combined diagnostic criteria and 3 isolated diagnostic criteria (WHO 2009, epidemiological link and NS1 antigenemia for dengue) with the gold standard of diagnosis, which was serological conversion. Results: 342 subjects participated in the study. 44% were school age and 70% were 5 years old or older. 52.76% (191) were male. Malnutrition and overweight were found in 13% and 2%, respectively. The combination of C-reactive protein with thrombocytopenia was found in 0.45% of patients without dengue and in 6% of patients with a final diagnosis of dengue (p=0.004). Conclusion: This result provides the alternative of using a simple combination of laboratory tests that can be replicated in emergency rooms and inpatient wards in a first contact with febrile patients with suspected dengue fever.

Síntomas gastrointestinales, disfunción respiratoria, hepática y renal, principales factores asociados a letalidad por rickettsiosis trasmitida por garrapatas en Mexicali, Baja California, México / Gastrointestinal symptoms, respiratory, hepatic and renal dysfunction, main factors associated with lethality due to tickborne rickettsiosis in Mexicali, Baja California, Mexico

INTRODUCCIÓN: La rickettsiosis, enfermedad potencialmente mortal, es trasmitida por vectores como Rhipicephalus sanguineus, Dermacentor variabilis y D. andersonii, reservorios de Rickettsia rickettsii. En Baja California, México, es endémica, multifactorial, tiene alta letalidad, sus manifestaciones clínicas inespecíficas y ataque multisistémico dificultan el diagnóstico y tratamiento oportuno. OBJETIVO: Identificar los factores de riesgo asociados a la letalidad por rickettsiosis trasmitida por garrapatas en Mexicali, Baja California. PACIENTES Y MÉTODOS : Estudio observacional, analítico, transversal, retrospectivo, de 40 registros de pacientes con diagnóstico confirmado de rickettsiosis, periodo 2014 a 2018. Variables analizadas: sociodemográficas, clínicas, laboratorio clínico, evolución y desenlace. Se reportan frecuencias y medidas de asociación. RESULTADOS: 24 defunciones y 16 vivos. Más de 90% tuvo contacto conocido con garrapatas. Afectó en su mayoría a < 45 años en ambos grupos. La evolución antes del ingreso fue similar y la estancia hospitalaria fue mayor en los pacientes vivos (3,2 ± 4.7 vs 10,62 ± 7,6 p = 0,0002). Fiebre, cefalea, mialgias fueron predominantes. Datos asociados con letalidad: disfunción respiratoria (OR 38,33 IC95% 4,06-361,3 p < 0,0001), creatinina elevada (OR 15,4 IC95% 3,08-76,77 p < 0,0003), retardo del llenado capilar (OR 13,0 IC95% 2,73-61,78 p = 0,0005), dolor abdominal (OR 8,33, IC95% 1,90-36,44 p = 0,0029), AST (OR 7,5, IC95% 1,69-33,27 p = 0,005). CONCLUSIÓN: Esta enfermedad requiere de identificación temprana de factores que se asocian con letalidad para un tratamiento oportuno y adecuado.

BACKGROUND: Rickettsiosis, a potentially fatal disease, is transmitted by vectors such as Rhipicephalus sanguineus, Dermacentor variabilis and D. andersonii, reservoirs of Rickettsia rickettsii. In Baja California, Mexico, it is endemic, multifactorial, has high lethality, its nonspecific clinical manifestations and multisystem attack make diagnosis and timely treatment difficult. AIM: Identify the risk factors associated with lethality due to tick-transmitted rickettsiosis in Mexicali, Baja California. METHODS: Observational, analytical, cross-sectional, retrospective study of 40 records of patients with a confirmed diagnosis of rickettsiosis, period 2014 to 2018. Analyzed variables: sociodemographic, clinical, clinical laboratory, evolution and outcome. Frequencies and association measures are reported. RESULTS: 24 patients died and 16 survived. More than 90% had reported contact with ticks. It mostly affected ≤ 45 years in both groups. The evolution before admission was similar, and the hospital stay was longer in patients who lived (3.2 ± 4.7 vs 10.62 ± 7.6 p = 0.0002). Fever, headache, and myalgia are predominant. Data associated with lethality: respiratory dysfunction (OR 38.33 95% CI 4.06-361.3 p < 0.0001), elevated creatinine (OR 15.4 95% CI 3.08-76.77 p < 0.0003), delayed capillary refill (OR 13.0, 95% CI 2.73-61.78 p = 0.0005), abdominal pain (OR 8.33, 95% CI 1.90-36.44 p = 0.0029), AST (OR 7.5, 95% CI 1.69-33.27 p = 0.005). CONCLUSION: This disease requires early identification of factors that are associated with lethality for timely and adequate treatment.

Fiebre de origen desconocido como forma de presentación de la enfermedad de Still del adulto

Introducción: La enfermedad de Still del adulto es una enfermedad reumática, inflamatoria, sistémica y crónica cuya prevalencia en la población caucásica se estima en 1 caso por cada 100 000 adultos Objetivo: Presentar un paciente adulto joven, con una fiebre de origen desconocido como forma de presentación de la enfermedad de Still del adulto. Caso clínico: Paciente de 29 años de edad con antecedente de fiebre reumática, con un ingreso hospitalario anterior; que presentó un cuadro febril no infeccioso, de 50 días de duración, al cual no se le determinó la causa. Un año después reapareció la fiebre, de similares características, asociada a poliartralgia, hepatoesplenomegalia, anemia, hiperferritinemia, neutrofilia, factor reumatoideo negativo y se constató un cuadro de pericarditis durante el ingreso. Se realizó el diagnóstico de enfermedad de Still del adulto, por exclusión. Se inició tratamiento con esteroides, desapareció la fiebre en las primeras 24 horas y el paciente tuvo una evolución favorable. Conclusiones: La enfermedad de Still del adulto puede presentarse como una fiebre de origen desconocido y se diagnostica por exclusión, ya que no existen manifestaciones clínicas ni pruebas de laboratorio, patognomónicas. La hiperferritinemia es útil para la sospecha diagnóstica.

Introduction: Adult Still's disease is a rheumatic, inflammatory, systemic and chronic disease whose prevalence in the Caucasian population is estimated at 1 case per 100,000 adults. Objective: To present a young adult patient with a fever of unknown origin as the presentation of adult Still's disease. Clinical case: 29-year-old patient with a history of rheumatic fever, with a previous hospital admission; who presented a non-infectious febrile illness lasting 50 days, for which the cause was not determined. A year later, the fever reappeared, with similar characteristics, associated with polyarthralgia, hepatosplenomegaly, anemia, hyperferritinemia, neutrophilia, negative rheumatoid factor, and pericarditis was noted during admission. The diagnosis of adult Still's disease was made by exclusion. Treatment with steroids was started, the fever disappeared in the first 24 hours and the patient had a favorable evolution. Conclusions: Adult Still's disease can present as a fever of unknown origin and is diagnosed by exclusion, since there are no pathognomonic clinical manifestations or laboratory tests. Hyperferritinemia is useful for diagnostic suspicion.

Fiebre en pacientes inmunodeprimidos

Introducción: La fiebre es un marcador de enfermedades infecciosas e inflamatorias que se da por una respuesta inmune innata y por diferentes mediaciones entre marcadores moleculares. En el paciente inmunodeprimido, uno o varios mecanismos inmunológicos pueden estar alterados, debido a que la respuesta inmune puede estar deprimida y la fiebre puede denotar un estado patológico grave subyacente. Se realizó una búsqueda exploratoria en las bases de datos PubMed/Medline, Scopus y Scielo entre septiembre y octubre de 2022. Se incluyeron los términos fiebre, pacientes inmunodeprimidos, tratamiento y sistema inmune. Se seleccionaron 41 artículos científicos con diferentes diseños epidemiológicos. Objetivo: Describir aspectos relacionados con la fisiopatología de la fiebre, el tratamiento de la presencia de fiebre en pacientes con virus de inmunodeficiencia humana y síndrome de inmunodeficiencia adquirida, así como también en pacientes receptores de trasplantes de órgano sólido y de trasplantes hematopoyéticos, pacientes neutropénicos y pacientes tratados con corticosteroides y terapia biológica. Desarrollo: El tratamiento del paciente inmunodeprimido con fiebre incluye aspectos fundamentales como una adecuada anamnesis y examen físico, además de pruebas diagnósticas orientadas para establecer la causa de la fiebre. En estos pacientes, las infecciones juegan un papel protagónico y su intervención temprana es fundamental para impactar en la morbimortalidad. Conclusiones: El paciente inmunodeprimido con presencia de fiebre presenta un panorama desafiante para su manejo médico integral. Entre otros aspectos es relevante considerar el tipo y tiempo de inmunosupresión, así como los factores de riesgo, con el fin de orientar los diagnósticos y tratamientos.

Introduction: Fever is a marker of infectious and inflammatory diseases that is caused by an innate immune response and by different mediations between molecular markers. In the immunocompromised patient, one or more immunological mechanisms may be altered because the immune response may be compromised, and fever may denote a serious underlying disease state. An exploratory search was conducted in the PubMed/Medline, Scopus, and Scielo databases between September and October 2022. The terms fever immunocompromised patients, treatment, and immune system. A total of 41 scientific articles with different epidemiological designs were selected. Objective: To describe aspects related to the pathophysiology of fever, management of the presence of fever in patients with Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome, as well as in patients who have received solid organ transplants and hematopoietic transplants, neutropenic patients and patients treated with corticosteroids and biological therapy. Developing: The approach to the immunocompromised patient with fever includes fundamental aspects such as an adequate history and physical examination, as well as diagnostic tests aimed at establishing the cause of the fever. In these patients, infections play a leading role and early intervention is essential to impact morbidity and mortality. Conclusions: The immunocompromised patient with the presence of fever presents a challenging panorama for his/her comprehensive medical approach. Among other aspects, it is relevant to consider the type and duration of immunosuppression, as well as the risk factors, to guide diagnoses and treatments.

Comparison of plasma inflammatory biomarkers between MIS-C and potentially serious infections in pediatric patients.

BACKGROUND: Inflammatory biomarkers have been used for the diagnosis and management of multisystemic inflammatory syndrome in children (MIS-C). We aimed to compare the clinical and laboratory findings of MIS-C cases versus other febrile cases cataloged as potentially suspected bacterial infection (non-MIS-C). METHODS: Unicentric ambispective observational cohort study (June 2020-February 2022). We analyzed demographics, clinical symptoms and laboratory findings in MIS-C cases and in non-MIS-C cases with febrile processes of patients under 15 years of age admitted to hospital. RESULTS: We enrolled 54 patients with potential suspected bacterial infection and 20 patients with MIS-C for analysis. Fever (100%), gastrointestinal (80%) and mucocutaneous findings (35%) were common in MIS-C patients, also hypotension (36.8%) and tachycardia (55%). Laboratory findings showed significantly elevated proBNP (70%), ferritin (35%), D-dimer (80%) and lymphopenia (55%) and thrombocytopenia (27.8%) in MIS-C cases. IL-6 values were high in non-MIS-C patients (92.6%). CONCLUSIONS: In the management of MIS-C patients, the dynamic monitoring of proBNP, ferritin, D-dimer, lymphocytes and platelets could be helpful to pediatricians to effectively evaluate the progress of MIS-C in the early phases, not IL-6 values. The applicability of the IL-6 level as a prognostic biomarker in MIS-C patients may require closer discussion. In addition, the optimal laboratory markers, as stated in our study, can help establish a biomarkers model to early distinguish the MIS-C versus non-MIS-C in patients who are admitted to febrile syndrome.

[Facing fever in the pediatric patient: Checklist as a tool for parents]. / Checklist como herramienta para los padres ante la fiebre en el paciente pediátrico.

INTRODUCTION: In Western Europe, 20%-40% of children with fever request health care. Most of them present trivial viral infections, however, it is essential in pediatrics to distinguish patients who present a severe infection. This process begins with the recognition of the seriousness and the subsequent search for medical attention by the parents. METHODOLOGY: Analytical and cross-sectional observational study. One hundred patients were selected in two health centers. Sociodemographic data were collected, together with the responses to a checklist containing the signs and symptoms to request health care in case of fever. Subsequently, the checklist was filled out by the pediatrician. RESULTS: The mean age of the patients was 5.41 years. 50% consulted in the first 48h of fever evolution. In 42%, the response to all the items on the checklist was exactly the same between the companion and the pediatrician. There were no significant differences according to variables: first episode of fever (P=.262), age of the patient (P=.859), having a sibling (P=.880), family relationship of the companion (P=.648) or educational level of the companion (P=.828). CONCLUSIONS: Medical consultations for fever in pediatrics are carried out very early. A high percentage do not present alarm signs when they consult. There is a need to expand training on the alarm signs of fever in all parents, regardless of the number of children, age or educational level. The checklist as a tool for home assessment of fever has received high marks for its usefulness.

Gingivoestomatitis en paciente pediátrico con infección por SARS-CoV-2 / Gingivostomatitis in pediatric patients with SARS-CoV-2 infection

Introducción: en la infección por SARS-CoV-2 las manifestaciones clínicas otorrinolaringológicas y maxilofaciales son las que se presentan en menor porcentaje, dentro las cuales se incluyen lesiones ulcerativas, ampollas, enantemas, compromiso gingival, otitis media aguda, conjuntivitis y parotiditis. Presentación del caso: paciente masculino de 36 meses (año y medio), sin antecedentes de importancia que fue llevado a consulta por fiebre, tos y odinofagia. Al examen físico se encontró hipertermia, hiperemia conjuntival, aftas orales y sangrado gingival. Los paraclínicos mostraron anemia microcítica hipocrómica, tiempos de coagulación normales, LDH con ligera elevación y la prueba RT-PCR para SARS-CoV-2 positiva. Se hospitalizó y se mantuvo en vigilancia durante 4 días, con adecuada evolución y posterior egreso. Discusión: aunque se ha evidenciado que el SARS-CoV-2 puede generar compromiso en distintos sistemas incluida la región oro facial, hasta el momento no se han informado casos de gingivoestomatitis secundaria a COVID-19. Conclusiones: las manifestaciones de la cavidad bucal pueden considerarse como síntomas atípicos en esta infección, por lo que es importante realizar diagnóstico diferencial descartando otras posibilidades patológicas que pudiesen generar dicha sintomatología.

Introduction: in SARS-CoV-2 infection, clinical otorhinolaryngologic and maxillofacial manifestations are the least frequent. The most reported include ulcerative lesions, vesicles, enanthema, gingival involvement and even acute otitis media, conjunctivitis, and parotiditis. Case presentation: a 33-months-old male patient, with no relevant history who was brought to the clinic for presenting with fever, cough, and odynophagia. Physical examination revealed hyperthermia, conjunctival hyperemia, oral aphthous ulcers and gingival bleeding. Diagnostic workup evidenced hypochromic microcytic anemia, normal coagulation times, slightly elevated LDH and positive RT-PCR test for SARS-CoV-2. He was hospitalized and monitored for 4 days, with adequate progression and subsequent discharge. Discussion: otorhinolaryngologic and maxillofacial manifestations are the least frequent, however, it has been evidenced that they can generate multiple compromises within this system, however, so far, no cases of COVID-19-related gingivostomatitis have been reported. Conclusions: oral manifestations can be considered atypical symptoms, since other pathological possibilities that could generate such symptomatology were ruled out.

Efficacy of current vaccines against recently isolated foot and mouth disease virus type A South America (Venezuela) in Egypt 2022

Foot and mouth disease is a highly contagious viral disease that poses a significant economic threat to cloven-hoofed animals, including cattle and sheep. The emergence of a novel foot and mouth disease virus-A isolate, FMDV-A-Egy-AHRI-RL385-Ven-2022, in Egypt in 2022 has raised concerns about its potential impact on existing vaccination programs. Given that vaccination is a key strategy for foot and mouth disease virus control, the present study was aimed to assess the cross-protective efficacy of both local and imported inactivated vaccines against this new threat. Through challenge experiments and serum neutralization tests, we observed limited effectiveness of both vaccine types. The calculated r1-values at 28 days post-vaccination indicated a minimal immune response to FMDV-A-Egy-AHRI-RL385-Ven-2022 (0.176 and 0.175 for local and imported vaccines, respectively). Challenge experiments further confirmed these findings, revealing 0percent protection from the local vaccine and only 20percent rotection from imported vaccines by day 7 post-challenge. These results underscore the urgent need to update existing foot and mouth disease virus vaccines in Egypt by incorporating the newly circulating FMDV-A-Egy-AHRI-RL385-Ven-2022 strain. This proactive measure is crucial to prevent future outbreaks and ensure effective disease control(AU)

La fiebre aftosa es una enfermedad vírica muy contagiosa que supone una importante amenaza económica para los animales biungulados, entre ellos el ganado vacuno y ovino. La aparición de un nuevo aislado del virus A de la fiebre aftosa, el FMDV-A-Egy-AHRI-RL385-Ven-2022, en Egipto en 2022 ha suscitado preocupación por su posible impacto en los programas de vacunación existentes. Dado que la vacunación es una estrategia clave para el control del virus de la fiebre aftosa, el objetivo del presente estudio fue evaluar la eficacia protectora cruzada de las vacunas inactivadas locales e importadas frente a esta nueva amenaza. Mediante experimentos de desafío y pruebas de seroneutralización, observamos una eficacia limitada de ambos tipos de vacuna. Los valores r1 calculados a los 28 días posvacunación indicaron una respuesta inmunitaria mínima frente a FMDV-A-Egy-AHRI-RL385-Ven-2022 (0,176 y 0,175 para las vacunas local e importada, respectivamente). Los experimentos de provocación confirmaron aún más estos resultados, revelando un 0 por ciento de protección de la vacuna local y sólo un 20 por ciento de protección de las vacunas importadas al séptimo día después de la provocación. Estos resultados subrayan la urgente necesidad de actualizar las vacunas existentes contra el virus de la fiebre aftosa en Egipto incorporando la nueva cepa circulante FMDV-A-Egy-AHRI-RL385-Ven-2022. Esta medida proactiva es crucial para prevenir futuros brotes y garantizar un control eficaz de la enfermedad(AU)

Estado reaccional de enfermedad de Hansen como causa de fiebre de origen desconocido

Los fenómenos reaccionales de la lepra son complicaciones inflamatorias que a menudo se presentan como verdaderas emergencias médicas durante el curso del tratamiento o incluso después de culminarlo. A menudo, los síntomas sistémicos como la fiebre pueden aparecer antes que las manifestaciones cutáneas y desconcertar al médico. Se realiza la presentación del caso de un paciente masculino, 39 años, sano, que acude con cuadro de 2 meses de evolución de fiebre, pérdida de peso, con posterior aparición de manchas rojas en todo el cuerpo. Se realizaron biopsia de piel y baciloscopia, con los cuales se pudieron llegar al diagnóstico de lepra.

The reactional phenomena of leprosy are inflammatory complications that often present as true medical emergencies during treatment or even after completion. Often, systemic symptoms such as fever can appear before skin manifestations and baffle the doctor. The case presented is a 39-year male patient, healthy, who consult with a 2-month history of fever, and weight loss, with subsequent appearance of red spots all over the body. A skin biopsy and smear microscopy were performed, with which leprosy was diagnosed.

Tuberculosis congénita: a propósito de un caso

La tuberculosis (TB) es una de las principales enfermedades infecciosas a nivel mundial y sigue siendo un grave problema de salud pública en muchos países. La Organización Mundial de la Salud (OMS) estima que un tercio de la población está infectada con TB y la tasa de infección aumenta casi un 1% por año. Esta revisión tiene como objetivo exponer la identidad de la tuberculosis congénita rara y fatal si no se trata y resaltar las características clínicas y la dificultad de diagnóstico y la conciencia entre los pediatras para realizar un manejo terapéutico inmediato desde el inicio de la sospecha. Este estudio se propone detectar que el pronóstico es malo para los recién nacidos, seguido de una evolución fatal cuando el diagnóstico se retrasa. Se presenta a continuación el caso de un recién nacido de sexo masculino de 24 días de vida por parto cesárea, por RPM nacido de una madre que presentó infección por SARS-COV-2 14 días previos al parto. A los 5 días de post parto adormecimiento y debilidad de miembros inferiores, sin síntomas respiratorios, posteriormente fiebre de 5 días de evolución, con diagnóstico de TB cerebral sin síntomas respiratorios, RN con fiebre y tos de 3 días, hepatomegalia de 4.5 cm, sin adenopatías. Ecografía abdominal dentro de parámetros normales, ecocardiograma con despegamiento pericárdico laminar, ecografía cerebral, ecografía abdominal fondo de ojo dentro de parámetros normales. Radiografía de tórax mostró infiltrado nodulillar difuso bilateral compatible con diseminación miliar tuberculosa. Al ingreso se inició cobertura antibiótica con Cefotaxima más Ampicilina a dosis meníngea. Analítica laboratorial al ingreso perfil hepático alterado, glóbulos blancos en rango, presentó granulaciones toxicas 3% y reactantes de fase aguda aumentados. Se realizó punción lumbar con cultivo de LCR negativo para gérmenes comunes y micobacterias por lo cual se descendió antibioticoterapia a completando 9 días totales. En muestras seriadas durante 3 días de líquido gástrico tinción de Ziehl-Neelsen BAAR +++ en las 3 muestras, GENEXPERT M. tuberculosis detectado y secreción traqueal tinción de BAAR +++. Inició terapia antibacilar H10/R20/Z20/E20. Durante su internación presenta alteración de perfil hepático por lo cual se ajusta dosis H5/R10/Z15/E15 en conjunto con Piridoxina. Durante tratamiento antibacilar a los 10 meses presentó en ecografía abdominal múltiples calcificaciones en hígado y ecografía cerebral de control con dilatación leve de los ventrículos laterales en ambos lados. Al finalizar tratamiento al examen físico se constató hígado a 2 cm RCD al año de vida, crecimiento y desarrollo normal para la edad, controles oftalmológicos y auditivos sin hallazgos patológicos. El recién nacido recibió 2 meses de HRZE y 10 meses de HR completando 12 meses totales de tratamiento en conjunto con Piridoxina hasta 10 días posterior a la suspensión de antibacilares y la madre recibió 4 meses de HRZE y 8 meses de HR completando 12 meses de tratamiento antibacilar.

Tuberculosis (TB) is one of the major infectious diseases worldwide and continues to be a serious public health problem in many countries. The World Health Organization (WHO) estimates that one third of the population is infected with TB and the infection rate is increasing by almost 1% per year. This review aims to expose the identity of rare and fatal congenital tuberculosis if left untreated and to highlight the clinical features and the difficulty of diagnosis and awareness among pediatricians to perform immediate therapeutic management from the onset of suspicion. This study aims to detect that the prognosis is poor for newborns, followed by a fatal course when diagnosis is delayed. The case of a 24-day-old male newborn by cesarean section, due to PROM born to a mother who presented SARS-COV-2 infection 14 days prior to delivery, is presented below. At 5 days postpartum, numbness and weakness of the lower limbs, without respiratory symptoms, later fever of 5 days of evolution, with a diagnosis of cerebral TB without respiratory symptoms, newborn with fever and cough of 3 days, hepatomegaly of 4.5 cm, without adenopathies. Abdominal ultrasound within normal parameters, echocardiogram with laminar pericardial detachment, brain ultrasound, fundus abdominal ultrasound within normal parameters. Chest X-ray showed bilateral diffuse nodular infiltrate compatible with tuberculous miliary dissemination. On admission, antibiotic coverage was started with Cefotaxime plus Ampicillin at a meningeal dose. Laboratory analysis on admission altered liver profile, white blood cells in range, presented 3% toxic granulations and increased acute phase reactants. A lumbar puncture was performed with a negative CSF culture for common germs and mycobacteria, for which antibiotic therapy was decreased to a total of 9 days. In serial samples for 3 days of gastric fluid Ziehl-Neelsen AFB staining +++ in the 3 samples, GENEXPERT M. tuberculosis detected and tracheal secretion AFB staining +++. He started H10/R20/Z20/E20 antibacillary therapy. During his hospitalization, he presented an alteration in the liver profile, for which the H5/R10/Z15/E15 dose was adjusted in conjunction with Pyridoxine. During antibacillary treatment at 10 months, abdominal ultrasound revealed multiple calcifications in the liver and control brain ultrasound with mild dilatation of the lateral ventricles on both sides. At the end of treatment, the physical examination confirmed the liver at 2 cm RCD at one year of life, normal growth and development for age, ophthalmological and hearing controls without pathological findings. The newborn received 2 months of HRZE and 10 months of HR, completing a total of 12 months of treatment in conjunction with Pyridoxine up to 10 days after the suspension of antibacillary drugs, and the mother received 4 months of HRZE and 8 months of HR, completing 12 months of treatment. antibacillary.

Francisco Javier Muñiz. Cirujano de guerra / Francisco Javier Muñiz. War Surgeon

Francisco Javier Muñiz nació en Monte Grande en 1795 y se graduó de médico en la Facultad de Medicina de la Universidad de Buenos Aires en 1822. Además de la medicina y la paleontología, Muñiz se desempeñó como cirujano de guerra en la guerra con el Brasil y en la guerra de la Triple Alianza. En 1871, encontrándose jubilado, se ofrece como voluntario en la lucha contra la epidemia de fiebre amarilla que asoló a la ciudad de Buenos Aires provocando 14.467 muertos. Muñiz falleció el 8 de abril de 1871 en cumplimiento del deber, contagiado de fiebre amarilla. Médico, periodista, paleontólogo, descubridor de la vacuna nativa contra la viruela y realizador de apuntes de lingüística, Francisco Javier Muñiz, representa uno de los grandes ejemplos para la sociedad argentina. (AU)

Francisco Javier Muñiz was born in Monte Grande in 1795 and graduated as a physician from the Faculty of Medicine of the University of Buenos Aires in 1822. In addition to medicine and paleontology, Muñiz served as a military surgeon in the War with Brazil and in the War of the Triple Alliance. In 1871, when he was retired, he volunteered to fight the yellow fever epidemic that devastated the city of Buenos Aires, causing 14,467 deaths. Muñiz died in the line of duty on April 8, 1871, infected with yellow fever. Doctor, journalist, paleontologist, discoverer of the native vaccine against smallpox and linguistic note-taker, Francisco Javier Muñiz is one of the great examples for Argentinian society. (AU)

Manifestaciones mucocutáneas de la fiebre de chikungunya / Mucocutaneous manifestations of chikungunya fever

Las manifestaciones típicas de la Chikungunya son la fiebre y las artralgias en la mayoría de los casos, pero debemos recordar que presentan manifestaciones mucocutáneas, donde la más frecuente es el exantema, además pueden presentar manifestaciones mucocutáneas atípicas con un gran polimorfismo simulando varias dermatosis como los casos expuestos anteriormente. Este reporte cuenta con 5 casos clínicos del mes de enero y febrero del año 2023 en el departamento Central de Paraguay, durante la mayor epidemia de Chikungunya registrada en el país hasta el momento. Es importante conocerlas y correlacionar con los demás signos y síntomas de la enfermedad para un diagnóstico y tratamiento adecuados.

The typical manifestations of Chikungunya are fever and arthralgia in most cases, but we must remember that they present mucocutaneous manifestations, where the most frequent is rash, they can also present atypical mucocutaneous manifestations with great polymorphism simulating various dermatoses such as cases outlined above. This report has 5 clinical cases from the month of January and February 2023 in the Central area of Paraguay, during the largest recorded Chikungunya epidemic in the country so far. It is important to know them and correlate them with the other signs and symptoms of the disease for proper diagnosis and treatment.

[Síndrome de fiebre periódica, adenitis, faringitis y aftosis en un preescolar con síndrome de Asperger: reporte de caso].

Background: Autoinflammatory diseases are a heterogeneous group of pathologies whose prevalence is undefined to date. Within these, the Periodic Fever Syndrome, Adenitis, Pharyngitis and Aphthosis (PFAPA) is determined as the most common and the most studied. Neurodevelopmental and behavioral disor- ders, including those of the Autism Spectrum, are especially prevalent in patients with allergic and autoimmune diseases, however, there is little documented regarding their relationship with autoinflammation. Case report: The case of a patient with Asperger Syndrome with subsequent onset of this autoinflammatory disease is shown. Two weekly blood counts and complete serum immunoglobulins are obtained, which do not show a decrease in neutrophil counts or sublevels or supralevels in immunoglobulins. Conclusion: When he returned to his follow-up appointment, he reported a feverish peak 2 days before, which ceased with the administration of the steroid, and if there was presence of oral ulcers on this occasion, fulfilling the modified Marshall criteria. Likewise, a great change is noted in their development and cooper- ation in exploration. The duality of this autoinflammatory syndrome in a patient with Asperger Syndrome is determined.

Antecedentes: Las enfermedades autoinflamatorias son un grupo heterogéneo de patologías cuya prevalencia es indefinida hasta nuestra actualidad. Dentro de estas, el Síndrome de Fiebre Periódica, Adenitis, Faringitis y Aftosis (PFAPA, por sus siglas en inglés) se determina como la más común y de las mayormente es- tudiadas. Las alteraciones del neurodesarrollo y la conducta, entre estas las del Espectro Autista, son especialmente prevalentes en pacientes con enfermedades alérgicas y autoinmunes, sin embargo, hay poco documentado en cuanto a su relación con la autoinflamación. Reporte de caso: Se muestra el caso de un paciente con Síndrome de Asperger con debut posterior de esta enfermedad autoinflamatoria. Se obtienen 2 biometrías hemáticas semanales e inmunoglobulinas séricas completas, las cuales no muestran descenso en conteos de neutrófilos ni infraniveles ni supraniveles en las inmunoglobulinas. Conclusión: Al reacudir a su cita de control refiere pico febril 2 días previos, el cual cesó con la administración del esteroide, ya si presencia de úlceras orales en esta ocasión, cumpliendo los criterios modificados de Marshall. Por igual, se nota un gran cambio en su desenvolvimiento y cooperación a la exploración. Se determina la dualidad de este síndrome autoinflamatorio en un paciente con Síndrome de Asperger.

[Síndrome hemofagocítico linfohistiocitario secundario a Dengue en una paciente de 6 años: reporte de caso].

Background: Dengue fever is a mosquito-borne infectious disease endemic in over 100 countries around the world. Among the complications that dengue can cause the Hemophagocytic Lymphohistiocytosis is one of great concern for its severity and complex diagnosis. Case report: Hereby we document a case of this disease expressed on a previously healthy 6-year-old female patient whose dengue infection was so severe that needed intensive care management with vasoactive drugs and diuretics. After a short period of wellness began newly with fever, pancytopenia, hepatitis, and inflammatory response symptoms. Conclusions: A Dengue associated Hemophagocytic Lymphohistiocytosis syndrome was suspected and treated with intravenous corticosteroids on a 3-day scheme at no signs of malignancy with excellent response. The health care professionals must know about this not novel entity in order to reach an efficient diagnosis and treatment mostly, but not only, those in tropical and sub-tropical regions of the word were dengue virus is endemic.

Antecedentes: La fiebre por dengue es una enfermedad infecciosa transmitida por mosquitos, endémica en más de 100 países alrededor del mundo. La Linfohistiocitosis Hemofagocítica, dentro de las complicaciones que puede ocasionar el dengue, es una de las más preocupantes por su complejidad diagnostica y gravedad. Reporte de caso: Femenino de 6 años de edad, previamente sana, cuya infección por dengue fue tan grave que requirió manejo en cuidados intensivos. Después de un breve período de bienestar recrudeció la fiebre, además de pancitopenia, hepatitis y síntomas de respuesta inflamatoria. Conclusiones: Se sospechó síndrome de Linfohistiocitosis Hemofagocítica asociada a Dengue y se trató con corticoides intravenosos en un esquema de 3 días con excelente respuesta. Los profesionales de la salud deben conocer esta entidad no novedosa para poder llegar a un diagnóstico y tratamiento eficaz en su mayoría, pero no solo, en las regiones tropicales y subtropicales del mundo donde el virus del dengue es endémico.