Varicela neonatal tardía: presentación en un paciente pediátrico / Late neonatalchickenpox: presentation in a pediatric patient

La varicela es una infección poco frecuente durante la gestación, el riesgo para el feto y las manifestaciones clínicas, variarán en función del momento del embarazo en que se produce la infección materna, cuando la erupción maculopapular materna se produce entre los 5 días previos al parto y las 48 horas posteriores, se habla de varicela neonatal tardía. La clínica es grave, con afectación visceral (pulmonar, cerebral, hepática, hemorragias cutáneas, etc.) y un 30 % de los casos desarrollarán una varicela fulminante. Se presenta el caso de neonato masculino que consultó por lesiones en piel, tipo pápulas eritematosas y vesiculares pleomorfas, de distribución dispersa. Con evolución clínica tórpida, permaneció 24 horas en la institución, con franco deterioro respiratorio y neurológico, compatible con cuadro de varicela neonatal tardía fulminante(AU)

Chickenpox is considered a rare infection during pregnancy, the risk to the fetus and the clinical manifestations will vary depending on the time of pregnancy when the maternal infection occurs, when the maternal maculo-papular injuries occurs within the previous 5 days after delivery and 48 hours after, there is talk of late neonatal chickenpox. The symptoms are severe with visceral involvement (lung, brain, liver, skin bleeding, etc.) and 30% of cases will develop fulminant chickenpox. We present the case of a male neonate who consults due to skin lesions, such as erythematous papules and pleomorphic vesicles, with scattered distribution. With a torpid clinical course, who remains in the institution for 24 hours, with frank respiratory and neurological deterioration compatible with late-neonatal fulminant varicella symptoms(AU)

Falla de inmunoglobulina específica varicela zoster en prevenir varicela neonatal: revisión a propósito de un caso clínico / Failure of varicella zoster specific immunoglobulin to prevent neonatal varicella: a review regarding a clinical case

La varicela neonatal es una patología grave. En Chile recientemente se incorporó la vacuna varicela al programa nacional de inmunizaciones, por lo que es aún es esperable que ocurra transmisión vertical. El manejo en el recién nacido incluye inmunoglobulina específica para virus varicela zoster cuando la madre inicia una varicela periparto. Presentamos el caso clínico de un neonato que cursó con una varicela grave pese a haber recibido profilaxis con inmunoglobulina específica. Se realizó una revisión de la literatura sobre varicela neonatal para sugerir recomendaciones de manejo. El uso de inmunoglobulina específica para virus varicela zoster, como profilaxis a un recién nacido expuesto, disminuye el riesgo de varicela neonatal pero no lo elimina.

Neonatal chickenpox is a serious pathology. In Chile, the varicella vaccine was recently incorporated into the national immunization program, so vertical transmission is still expected. Newborn management includes specific immunoglobulin for varicella zoster virus when the mother initiates peripartum chickenpox. We present a case of a newborn who has severe chickenpox despite having received prophylaxis with immunoglobulin, and a review of the literature on neonatal chickenpox was carried out to suggest management recommendations. The use of specific immunoglobulin for varicella zoster virus as prophylaxis in an exposed newborn reduces the risk of neonatal chickenpox but does not eliminate it.

Varicela congénita / Congenital varicella syndrome

Introducción: la infección por virus de varicela zóster (VVZ) durante el embarazo se engloba en el espectro de infecciones STORCH (acrónimo de sífilis, toxoplasmosis, otros, rubéola, citomegalovirus y herpes virus), debido a su potencial teratogénico y sus posibles repercusiones en el bienestar fetal. A pesar de que solo 2% de las pacientes con infección por VVZ en el embarazo tendrán fetos con síndrome congénito de varicela, su alta morbimortalidad hace necesario conocer posibles formas de prevención. Presentación del caso: en nuestro caso, una madre de 27 años da a luz un neonato con múltiples malformaciones óseas y lesiones cutáneas típicas, asociadas con malformaciones cardiacas y calcificaciones viscerales evidenciadas por imagenología. Ante la comprobación clínica y paraclínica de la infección, se diagnosticó síndrome congénito de varicela. El paciente presentó una evolución tórpida desde el nacimiento, con neumonía multirresistente, enterocolitis necrotizante y rápido deterioro de su patrón respiratorio con posterior fallecimiento. Conclusión: en la actualidad la vacunación y el uso de inmunoglobulina posexposición son los principales aliados para la prevención de este síndrome en recién nacidos.

Introduction: infection with the varicella zoster virus (VZV) during pregnancy is encompassed within the spectrum of STORCH infections (acronym for syphilis, toxoplasmosis, others, rubella, cytomegalovirus and herpes virus), due to its teratogenic potential and impact on fetal well-being. Although only 2% of patients with VZV infection in pregnancy had fetuses with congenital varicella syndrome, its high morbidity and mortality makes it necessary to be aware of the proper use of prevention strategies. In our case, a 27-year-old mother gives birth to a newborn with multiple skeletal anomalies and typical lesions of the skin, associated with cardiac malformations and visceral calcifications diagnosed by imaging. Congenital varicella syndrome was diagnosed upon clinical and paraclinical confirmation of infection. Case presentation: the patient presented a torpid evolution from birth, with multidrug-resistant pneumonia, necrotizing enterocolitis and rapid deterioration of his respiratory pattern leading to death. Conclusion: currently, vaccination and the use of post-exposure immunoglobulin are the main allies for the prevention of this syndrome in newborns.

Cobertura y barreras de la vacunación contra la varicela en niños que consultaron a la Fundación Salud Bosque / Coverage of and Barriers to Varicella Vaccination in Children at Fundación Salud Bosque / Cobertura e barreiras à vacinação contra varicela em crianças que consultaram a Fundação Salud Bosque

Introducción. Desde la introducción de la vacuna contra la varicela a Colombia no se ha logrado una cobertura mayor al 90%. El objetivo de este trabajo es identificar las barreras de vacunación contra varicela en niños. Metodología. Estudio descriptivo realizado en la Fundación Salud Bosque; se estudiaron 27 pacientes, 18 hombres (67%) y 9 mujeres (33%), incluyendo menores de 18 años con varicela, y excluyendo pacientes con enfermedades ampollosas distintas a varicela y quemaduras. Se hizo una caracterización demográfica. Para las variables cuantitativas se emplearon promedios y desviación estándar, y para las cualitativas la razón de proporción con Stata V12®. Resultados. La incidencia de varicela fue del 0.2%, solo 9 pacientes (33%) habían recibido la primera dosis de la vacuna, ninguno la segunda dosis. El 92.5% requirió incapacidad; el 89% analgésicos; el 63% antihistamínicos y el 26% antibióticos. Discusión. El estudio realizado demuestra una incidencia significativamente menor en contraste con otras cohortes internacionales. En Colombia no se ha alcanzado la cobertura de la vacunación contra la varicela lograda en Uruguay, Costa Rica, Estados Unidos, Australia, Europa y Taiwán dadas las mismas barreras en su aplicación, mientras que en África no se ha introducido la vacuna contra la varicela porque existen otras prioridades como la desnutrición, la malaria y la infección por Virus de la Inmunodeficiencia Humana. Conclusiones. La cobertura de la vacunación no se ha logrado por barreras modificables que incrementan la incidencia y carga de la enfermedad por costos debido a incapacidad, manejo farmacológico y ausentismo escolar. Palabras clave: Cobertura de Vacunación; Incidencia; Niño; Vacuna contra la Varicela; Varicela.

Introduction. Ever since the introduction of the varicella vaccine in Colombia, coverage has not surpassed 90%. The objective of this work is to identify the barriers to varicella vaccination in children. Methodology. A descriptive study conducted at Fundación Salud Bosque. 27 patients were studied - 18 males (67%) and 9 females (33%) - including children under 18 years of age with varicella, and excluding patients with blistering diseases other than varicella and burns. A demographic characterization was conducted. Averages and standard deviations were used for quantitative variables, and the proportion ratio was used for qualitative variables with Stata V12®. Results. The incidence of varicella was 0.2%. Only 9 patients (33%) had received the first dose of the vaccine, and none had received the second dose. 92.5% required sick leave, 89% required painkillers, 63% required antihistamines, and 26% required antibiotics. Discussion. The conducted study shows a significantly lower incidence compared to other international cohorts. Colombia has not achieved the varicella vaccination coverage of Uruguay, Costa Rica, the United States, Australia, Europe and Taiwan due to the barriers to applying it. Meanwhile, the varicella vaccine has not been introduced in Africa because there are other priorities, such as malnutrition, malaria and the Human Immunodeficiency Virus infection. Conclusions. Vaccination coverage has not been achieved because of modifiable barriers that increase the incidence and burden of the disease due to costs of sick leave, pharmacological treatment and school absenteeism. Keywords: Vaccination Coverage; Incidence; Child; Chickenpox Vaccine; Chikenpox.

Introdução. Desde a introdução da vacina contra varicela na Colômbia, não foi alcançada uma cobertura superior a 90%. O objetivo deste trabalho é identificar as barreiras à vacinação contra varicela em crianças. Metodologia. Estudo descritivo realizado na Fundação Salud Bosque. Foram estudados 27 pacientes, 18 homens (67%) e 9 mulheres (33%), incluindo crianças menores de 18 anos com varicela e excluindo pacientes com outras doenças bolhosas que não varicela e queimaduras. Foi feita uma caracterização demográfica. Média e desvio padrão foram utilizados para as variáveis quantitativas e, para variáveis qualitativas, a razão de proporção com Stata V12®. Resultados. A incidência de varicela foi de 0.2%, apenas 9 pacientes (33%) receberam a primeira dose da vacina, nenhum a segunda dose. 92,5% requeriam atestado; 89% analgésicos; 63% anti-histamínicos e 26% antibióticos. Discussão. O estudo realizado mostra uma incidência significativamente menor em comparação com outras coortes internacionais. A Colômbia não tem atingido a cobertura vacinal contra a varicela alcançada no Uruguai, Costa Rica, Estados Unidos, Austrália, Europa e Taiwan, dadas as mesmas barreiras em sua aplicação, enquanto na África a vacina contra a varicela não foi introduzida porque existem outras prioridades como a desnutrição, a malária e a infecção pelo Vírus da Imunodeficiência Humana. Conclusões. A cobertura vacinal não foi alcançada dadas as barreiras modificáveis que aumentam a incidência e carga da doença devido aos custos por atestados, manejo farmacológico e absenteísmo escolar. Palavras-chave: Cobertura Vacinal; Incidência; Criança; Vacina contra Varicela; Varicela

Síndrome hemofagocítico asociado a varicela / Hemofagocytic syndrome associated with varicella

Presentación del caso. Lactante femenina de 14 meses de edad con desarrollo psicomotor normal, sin comórbidos. Con historia de un día de fiebre de 40 °C, intermitente, acompañada de evacuaciones diarreicas y vómitos. Fue llevada por sus padres a una clínica privada sin notar mejoría con el tratamiento médico indicado. Posteriormente, presentó deterioro clínico y fue llevada a un hospital, donde se diagnosticó un síndrome febril agudo, diarrea con deshidratación leve y faringitis. Al cuarto día de evolución inició con máculas y pápulas que progresaron a vesículas y costras. Además, presentó intolerancia a la vía oral, disnea, distensión abdominal, coma y desequilibrio hidroelectrolítico. Intervención terapéutica. Inició el tratamiento con hidratación parenteral, antivirales, esteroides endovenosos y antihistamínicos; se diagnosticó shock séptico con compromiso respiratorio, se proporcionó ventilación mecánica asistida y fue referida al hospital de tercer nivel para atención por medicina crítica. Los estudios reportaron un derrame pleural derecho del 40 % y hepatomegalia. Continuó el tratamiento con antibiótico terapia, hidratación parenteral, antivirales, diuréticos, antipiréticos y hemoderivados, presentó mejoría, continuó el manejo terapéutico. Evolución clínica. El día 18 presentó fiebre, hepatoesplenomegalia, los exámenes reportaron elevación de ferritina, triglicéridos y citopenia se diagnosticó un síndrome hemofagocítico que evolucionó con una falla multisistémica y falleció al siguiente día

Case presentation. A 14-month-old female infant with normal psychomotor development, without comorbidities. With a one-day history of fever of 40 °C, intermittent, accompanied by diarrhea and vomiting. She was taken by her parents to a private clinic without improvement with the indicated medical treatment. Subsequently, she presented clinical deterioration and was taken to a hospital, where she was diagnosed with acute febrile syndrome, diarrhea with mild dehydration, and pharyngitis. On the fourth day of evolution, she started with macules and papules that progressed to vesicles and crusts. In addition, she presented oral intolerance, dyspnea, abdominal distension, coma, and hydro electrolytic imbalance. Therapeutic intervention. She started treatment with parenteral hydration, antivirals, intravenous steroids, and antihistamines; septic shock with respiratory distress was diagnosed, assisted mechanical ventilation was provided, and she was referred to a tertiary hospital for critical care medicine. Studies reported a 40 % right pleural effusion and hepatomegaly. She continued treatment with antibiotic therapy, parenteral hydration, antivirals, diuretics, antipyretics, and hemoderivatives, presented improvement, and continued therapeutic management. Clinical evolution. On day 18 he presented fever and hepatosplenomegaly. Tests reported elevated ferritin, triglycerides, and cytopenia, and was diagnosed with hemophagocytic syndrome that evolved with multisystemic failure and died the following day

Pitiriasis liquenoide varioliforme aguda posterior al inicio de eritropoyetina / Acute varioliform lichenoid pityriasis following the initiation of erythropoietin

Resumen La pitiriasis liquenoide varioliforme aguda (PLEVA) pertenece a un grupo de enfermedades categorizadas como pitiriasis liquenoides, junto con la enfermedad febril úlcero-necrótica de Mucha-Habermann y la pitiriasis liquenoide crónica (PLC). Se caracteriza por la aparición aguda de múltiples pápulas eritemato-violáceas con posterior necrosis, discromía residual y cicatrices varioliformes. Dentro de las teorías patogénicas propuestas se encuentra el posible papel de agentes infecciosos, trastornos linfoproliferativos, complejos inmunes e incluso, asociación a medicamentos. Se presenta un casode una mujer adulta con un cuadro típico de PLEVA con confirmación histopatológica, cuyas lesiones aparecieron posteriormente al inicio de eritropoyetina.

Abstract Pityriasis lichenoides et varioliformes acuta (PLEVA) is part of a group of diseases clustered as pityriasis lichenoides, next to febrile ulceronecrotic Mucha-Habermann disease and pityriasis lichenoides chronica. It's characterized by a sudden onset of multiple erythematous and violaceous papules which develop necrosis, leaving residual dyschromia and varioliform scars. It's been hypothesized the possible role of infectious agents, lymphoproliferative diseases, immune complexes and drugs. We present the case of a woman with a typical PLEVA with histopathological confirmation, whose lesions appeared after therapy with erythropoietin.

Síndrome de Ramsay Hunt en paciente epiléptico en Santander, Colombia: Reporte de caso / Ramsay Hunt Syndrome in an epileptic patient in Santander, Colombia: Case report

El Síndrome de Ramsay Hunt es una entidad infrecuente, con una incidencia de 5 por cada 100.000 personas por año. Esta condición se caracteriza por una reactivación del virus de la varicela-zoster en el nervio facial. Su diagnóstico implica un reto para el médico puesto que suele ser netamente clínico, con la aparición de una triada consistente en: otalgia, parálisis facial ipsilateral y vesículas en el canal auditivo. El objetivo del artículo es presentar el caso de una mujer de 49 años de edad, con antecedente de epilepsia en tratamiento anticonvulsivante, quien ingresa con la triada clínica antes descrita, asociada a visión borrosa derecha y vértigo. La paciente fue tratada con antivirales y corticoides orales, presentando una resolución clínica favorable dado una reducción de más del 50% de las lesiones cutáneas. No se identificaron diferencias respecto a la presentación clínica de este síndrome al compararse con pacientes no epilépticos.

Ramsay Hunt Syndrome is a rare entity, with an incidence of 5 per 100,000 people per year. This condition is characterized by a reactivation of the varicella-zoster virus in the facial nerve. Its diagnosis implies a challenge for the physician since it is usually a clinical diagnosis, with the appearance of a clinical triad consisting of: otalgia, ipsilateral facial paralysis and vesicles in the ear canal. The objective of the article is to present the case of a 49-year-old woman, with a history of epilepsy receiving anticonvulsant treatment, who was admitted with the aforementioned clinical triad, associated with blurred right vision and vertigo. The patient was treated with oral antiviral management and oral corticosteroids, presenting a favorable clinical resolution given a reduction of more than 50% of the skin lesions. No differences were identified regarding the clinical presentation of this syndrome when compared with non-epileptic patients.

Rehabilitación protésica en defecto ocular provocado por herpes zóster / Prosthetic Rehabilitation in Ocular Defect Caused by Herpes Zoster

El herpes zóster es el cuadro clínico constituido por las manifestaciones dermatológicas (erupción vesiculosa) y neurológica (dolor). Es la expresión de la recurrencia del virus varicela-zóster latente en los ganglios sensitivos, su aparición se favorece por el envejecimiento y la inmunosupresión con una prevalencia que se estima en un 20 %. Se describe los pasos clínicos para la confección de una prótesis ocular en el mejoramiento estético a un paciente con defecto ocular en ojo izquierdo provocado por herpes zoster. Se trata de un paciente masculino de piel blanca de 50 años de edad, que acudió a la consulta de prótesis del Policlínico Universitario Julio Antonio Mella de la provincia Camagüey remitido del Servicio de Oculoplastia del Hospital Universitario Manuel Ascunce Domenech con diagnóstico de defecto ocular izquierdo por evisceración como consecuencias de infección por herpes zoster y antecedente de inmunodepresión. El paciente expuso que la pérdida ocular fue por las complicaciones que se fueron sucediendo en la medida que se agravó su cuadro clínico. Además, refirió que presentaba dolor en la zona y que le irradiaba a la cabeza y que le preocupaba su estética. Se determinó la elaboración de una prótesis ocular acrílica para mejorar el aspecto estético, lo cual permitió que el paciente mejorara su autoestima y calidad de vida(AU)

Herpes zoster is the clinical picture constituted by dermatological (vesicular rash) and neurological (pain) manifestations. It is the expression of the recurrence of the latent varicella-zoster virus in the sensitive ganglia, its appearance is favored by aging and immunosuppression with a prevalence estimated at 20%. We describe the clinical steps for the fabrication of an ocular prosthesis for the aesthetic improvement of a patient with ocular defect in the left eye caused by herpes zoster. This is a 50-year-old male patient with white skin, who came to the prosthesis consultation of the Julio Antonio Mella University Polyclinic in Camagüey province, referred from the Oculoplasty Service of the Manuel Ascunce Domenech University Hospital with a diagnosis of left ocular defect due to evisceration as a consequence of herpes zoster infection and a history of immunosuppression. The patient explained that the ocular loss was due to the complications that occurred as his clinical condition worsened. In addition, he reported that he had pain in the area that radiated to the head and that he was concerned about his esthetics. It was decided to make an acrylic ocular prosthesis to improve the esthetic aspect, which allowed the patient to improve his self-esteem and quality of life(AU)

Varicela en un hombre de 33 años / Varicella in one man of 33 years

Resumen Presentamos el caso de un hombre campesino de 33 años de edad, inmunocompetente, quien presentó cuadro clínico agudo con máculas, pápulas y vesículas simultáneas, generalizadas, de 10 dias de evolución, con fiebre y conjuntivitis. Se sospechó varicela, la cual se confirmó con frotis directo y biopsia de piel con inmunohistoquímica. El paciente mejoró y curó sin complicaciones y sin tratamiento antiviral. Es un caso interesante al tratarse de un hombre adulto, sin inmuno supresión ni enfermedad de base predisponente, con manifestaciones floridas e importante compromiso cutáneo, con evolución satisfactoria. Revisamos aspectos generales de la varicela, de su incidencia en Colombia y de los programas de vacunación.

Abstract We describe a case of varicella in one immunocompetent man of 33 years, who consulted by cutaneous lesions consistent in maculopapular and vesicles generali zed after 10 days of evolution, accompanied by fever and conjunctivitis. Diagnosis of varicella was confirmed by direct stain and biopsy with immunohistochemistry analysis. The patient improved without antiviral treatment and no complications. We consider this caes of interest because its inusual presentation in one man without immunodeficiency nor subjacent disease. We reviewed the situation of varicella in Colombia and of the vaccination programs.

Infecção por Varicela-Zóster em paciente imunossupresso com complicações graves e inesperado desfecho clínico favorável / Varicella Zoster virus infection in immunosuppressed patient with serious complications and unexpected favorable clinical outcome / Infección por Varicela Zóster en paciente inmunosuprimido con complicaciones graves y evolución clínica favorable inesperada

O vírus varicela-zóster pode recorrer diante de imunodeficiência. A falta de imunidade celular pode ser tão grave a ponto de comprometer o sistema nervoso central. Neste caso, o paciente apresentou quadro de aids com meningoencefalopatia por vasculite. Pela alta suspeição diagnóstica, foi iniciado tratamento, empírica e precocemente, com aciclovir, corticoide e anticonvulsivante endovenosos. O diagnóstico se deu posteriormente. Com base neste caso, foi proposta uma estratégia eficaz de atendimento.

Varicella zoster virus infection may recur in the face of immunodeficiency, which can be so severe as to compromise the central nervous system. In the case studied, the patient presented a clinical picture of AIDS along with vasculitis meningoencephalopathy. Due to high diagnostic suspicion, intravenous Acyclovir, Corticosteroid and Intravenous Anticonvulsant were administered early. Diagnosis occurred later. On this case, an effective care strategy was proposed.

El virus de la varicela zóster puede reaparecer ante una inmunodeficiencia. La falta de inmunidad celular puede ser tan grave como para comprometer el sistema nervioso central. En este caso, el paciente desarrolló SIDA junto con meningoencefalopatía por vasculitis. Debido a la alta sospecha diagnóstica, se inició de forma empírica y precoz Aciclovir, corticoides y anticonvulsivantes intravenosos. Después, se realizó el diagnóstico. A partir de este caso se planteó una estrategia de atención eficaz.

Correlación entre casos de varicela y búsquedas en Google en Perú / Correlation between cases of chickenpox and Google searches in Peru

Con el objetivo de determinar la correlación entre los casos de varicela notificados en Perú y las búsquedas sobre varicela realizadas en Google a nivel nacional y por regiones se realizaron análisis de correlación de Spearman para las semanas epidemiológicas del 2016 al 2019, así como antes y después de la introducción de la vacuna para varicela en el Perú. A nivel nacional, se encontró una alta correlación antes del inicio de la vacunación (Rho 0,778, p = 0,001) y moderada durante el periodo de vacunación (Rho 0,441, p = 0,001). Algunas regiones tuvieron una correlación baja o muy baja y dejaron de ser estadísticamente significativas luego de la introducción de la vacuna en el Perú. Además, el cambio en la estacionalidad de la varicela durante el periodo de vacunación también tuvo un impacto en las búsquedas que realiza la población en Google.

Abstract In order to determine if there is a correlation between chickenpox cases reported in Peru and the chickenpox searches carried out on Google at national level and by regions, Spearman's correlation analyzes were carried out for the epidemiological weeks from 2016 to 2019, as well as before and after the introduction of the chickenpox vaccine in Peru. At the national level, a high correlation was found before the start of vaccination (Rho 0.778, p = 0.001) and moderate during the vaccination period (Rho 0.441, p = 0.001), some regions had a low or very low correlation and stopped to be statistically significant after the introduction of the vaccine in Peru. In addition, the change in the seasonality of chickenpox during the vaccination period also had an impact on the searches carried out by the population on Google.

Estudio de líquido cerebroespinal en el síndrome de Ramsay-Hunt: controversia a raíz de un caso clínico / Study of cerebrospinal fluid in Ramsay-Hunt syndrome: controversy because of a clinical case

El Síndrome de Ramsay-Hunt (SRH), es la segunda causa de parálisis facial periférica (PFP). Causado por el virus Varicella zoster (VVZ), ipsilateral a la PFP,presenta unaerupción herpetiforme y cefalea en distribución del nervio facial. Presentamos el caso de una mujer, 54 años, con SRH y cefalea persistente cuyo líquido cerebroespinal (LCE) fue compatible con meningitis. Se indicó aciclovir endovenoso (EV). La literatura no recomienda estudio de LCE en PFP; y en SRH se sugiere en inmunosuprimidos y complicaciones del SRH como queratopatía, accidentes-cerebrovasculares, y meningitis. Un LCE alterado en SRH, indica modificar la conducta terapéutica.

Ramsay-Hunt Syndrome (RHS) is the second leading cause of peripheral facial palsy (PFP). Caused by the Varicella zoster virus (VZV), ipsilateral to the PFP, it presents a herpetiform rash and headache in the facial nerve distribution. We present the case of a 54-year-old woman with RHS and persistent headache whose cerebrospinal fluid (CSF) was compatible with meningitis. Intravenous acyclovir was indicated. The literature does not recommend an CSF study in PFP; in RHS it is suggested in immunosuppressed patients and complications of RHS such as keratopathy, cerebrovascular accidents, and meningitis. An altered CSF in RHS indicates modifying the therapeutic conduct.

Oftalmoplejía infecciosa en un paciente con virus de la varicela-zóster / Infectious ophthalmoplegia in patients with varicella-zoster virus

Introducción: Una de las complicaciones de la reactivación del virus de la varicela-zóster es el compromiso de los nervios craneales; sin embargo, es inusual que se presente como una oftalmoplejía completa. Objetivo: Describir el caso de un adulto inmunocompetente que desarrolló una oftalmoplejía infecciosa por reactivación del virus de la varicela-zóster. Caso clínico: El paciente presentó alteración completa de la motilidad de los músculos extraoculares del ojo izquierdo con compromiso del reflejo pupilar, disminución en la agudeza visual y neuralgia trigeminal concomitante; no tuvo signos o síntomas sugestivos de encefalitis o meningitis. Días antes de la oftalmoplejía aparecieron vesículas en la región frontal y periorbitaria izquierdas. Mediante el estudio del líquido cefalorraquídeo (LCR) con panel para meningitis/encefalitis FilmArray® se documentó positividad solo para el virus de la varicela-zóster. El paciente fue tratado con aciclovir, esteroides y neuromoduladores, con lo cual obtuvo mejoría parcial de sus síntomas a las dos semanas. La discusión se realizó a partir de los pocos reportes de casos encontrados en diferentes bases de datos. Conclusiones: Este caso amplía el entendimiento clínico y terapéutico de una manifestación inusual de esta enfermedad frecuente, que combina un compromiso patológico de varios nervios craneales por la reactivación del virus de la varicela-zóster.

Introduction: Cranial nerve involvement is one of the complications of varicella-zoster virus reactivation; however, presenting complete ophthalmoplegia is unusual. Objective: To describe the case of an immunocompetent adult who developed an infectious ophthalmoplegia due to varicella-zoster virus reactivation. Clinical case: The patient presented complete alteration of the extraocular muscle motility of the left eye with pupillary reflex compromise, decrease in visual acuity and concomitant trigeminal neuralgia. The patient did not present signs or symptoms suggestive of encephalitis or meningitis. Days before the ophthalmoplegia, vesicles appeared in the left frontal and periorbital regions. Cerebrospinal fluid (CSF) examination with FilmArray® meningitis/encephalitis panel documented positivity for varicella-zoster virus only. The patient was treated with acyclovir, steroids and neuromodulators, resulting in partial improvement of his symptoms after two weeks. The discussion was based on the few case reports found in different databases. Conclusions: This case broadens the clinical and therapeutic understanding of an unusual manifestation of this common disease, which combines pathologic involvement of several cranial nerves due to varicella-zoster virus reactivation.

Situação vacinatória da tríplice e da tetra viral em crianças matriculadas na Educação Infantil / The vaccination situation of triple and tetra viral in children enrolled in Early Childhood Education

Objetivo Descrever a situação vacinal de crianças matriculadas nos Centros Municipais de Educação Infantil da Zona Sul do município de Natal, Rio Grande do Norte com relação às vacinas de tríplice e tetra viral. Método Trata-se de um estudo epidemiológico, descritivo e retrospectivo, realizado a partir da análise de cartões de vacina de crianças matriculadas em 15 instituições, nas quais foi possível reunir 773 cartões que foram analisados a partir do calendário básico de vacinação do ano 2015. Os cartões foram classificados em: esquema vacinal completo, incompleto e/ou não vacinado. Resultados Observou-se que 576 (75,51%) crianças estavam com o esquema vacinal completo, sendo o esquema considerado finalizado com a segunda dose da tríplice ou com a tetra viral. A melhor situação vacinal foi atingida nas crianças de dois a quatro anos, com uma cobertura de 84,31%, sendo que 83,3% das crianças dessa faixa etária estavam com o esquema completo e 12,79% das crianças estavam com o esquema vacinal incompleto. Um total de 67 crianças (8,66%) não apresentaram registros de vacina. Com relação à tetra viral, 226 crianças (29,73%) apresentaram esquema vacinal completo. Conclusão Os resultados obtidos no presente estudo revelam uma situação vacinal abaixo da meta estabelecida pelo Programa Nacional de Imunização.

Objective To describe a vaccination situation of children up to 8 years old from the Municipal Centers of Early Childhood Education in the South Zone of the city of Natal, Rio Grande do Norte for vaccines of triple and tetra viral. Method This is an epidemiological, descriptive and retrospective study, carried out based on the analysis of vaccination cards for children from 15 institutions, where it was possible to gather 773 cards, a course based on the basic calendar of the year 2015. They were classified in: complete, incomplete and/or unvaccinated vaccination schedule. Results It is observed that 576 (75.51%) of the children have a complete vaccination schedule, the schedule being completed with a second dose of triple or tetra viral. The best vaccination status was achieved in children aged 2 to 4 years with a coverage of 84.31% and 83.3% children with the complete regimen. We have 12.79% of children with an incomplete vaccination schedule. A total of 67 children (8.66%) who did not have any vaccine records. Regarding Tetra Viral, 226 children (29.73%) had a complete vaccination schedule. Conclusion The results obtained in this study reveal a vaccination situation below the target established by the National Immunization Program.

Meningoencefalitis por virus Varicella-Zóster posterior a infección por SARS-CoV2: Reporte de dos casos / Meningoencephalitis caused by Varicella-Zoster virus after SARS-CoV2 infection: Two cases report

RESUMEN La meningoencefalitis por el VZV es una patología poco frecuente que se presenta con la reactivación del virus dentro del organismo. OBJETIVO: Describir la presentación clínica de dos pacientes con neuroinfección por VZV posteriormente a infección por SARS-CoV-2. REPORTE DEL CASO: El primer caso corresponde a un hombre de 59 años con antecedente de neumonía moderada por SARS-CoV-2 que después cursó con meningoencefalitis por VZV y, además, desarrolló un síndrome de Ramsay Hunt. El segundo caso es el de una mujer de 37 años con antecedente de infección leve por SARS CoV-2 con un cuadro de cefalea con signos de alarma, en quien se documentó neuroinfección por VZV

ABSTRACT Meningoencephalitis caused by varicella zoster virus is a rare pathology that presents due to the reactivation of the virus in the organism OBJECTIVE: To describe the clinical presentation of two patients with VZV neuroinfection presented after a SARS CoV-2 infection. CASE REPORT: The first case is a 59 year old male with previous moderate SARS CoV-2 infection who presented meningoencephalitis and was diagnosed with Ramsay Hunt's Syndrome. The second case is a 37 year old female with previous SARS CoV-2 infection who presented with an acute onset headache and was documented with VZV neuroinfection.

Complications of herpes zoster hospitalizations in a reference hospital in Fortaleza-Ceará, 2009-2018 / Complicações de internações por herpes zoster em um hospital de referência em Fortaleza-Ceará, 2009-2018

Objective: the aim of this study was to relate sociodemographic, epidemiological and clinical conditions to the occurrence of severe cases of HZ in reference hospital of Fortaleza. Methods: this is a cross-sectional analytical study, based on medical records of patients admitted from 2009 to 2018. Pearson's x2 test or Fisher's exact test were used when appropriate. Results: we analyzed 196 medical records. The presence of complications occurred in 69.9%, the most affected region was the cranial (68.9%), and 1.5% died. The presence of vesicles (PR=1.37; 95%CI: 1.03-1.82; p=0.01) and the choice of antibiotic associated antiviral therapy (PR=0.58; 95%CI: 0.46-0.73; p=0.00) were significantly associated with the severity. Conclusions: the disease may be more severe at ages over 50. The presence of lesions in vesicles was associated with a higher prevalence of complications and the use of antibiotics and antivirals as a protective factor.

Objetivo: relacionar condições sociodemográficas, epidemiológicas e clínicas à ocorrência de casos graves de HZ em hospital de referência de Fortaleza. Métodos: trata-se de um estudo analítico transversal, baseado em prontuários de pacientes internados de 2009 a 2018. Foram utilizados o teste x2 de Pearson ou o teste exato de Fisher, quando apropriado. Resultados: foram analisados 196 prontuários. A presença de complicações ocorreu em 69,9%, a região mais acometida foi a craniana (68,9%), e 1,5% foi a óbito. A presença de vesículas (RP=1,37; IC95%: 1,03-1,82; p=0,01) e a escolha da terapia antiviral associada a antibióticos (RP=0,58; IC95%: 0,46-0,73; p=0,00) foram significativamente associadas com a gravidade. Conclusões: a doença pode ser mais grave a partir dos 50 anos. A presença de lesões em vesículas foi associada à maior prevalência de complicações e o uso de antibióticos e antivirais como fator de proteção.

Number of cases of varicella and hospitalization in a pediatric reference hospital in brazil after introducing the vaccine / Avaliação do número de casos e do perfil de internações por varicela em hospital pediátrico após a introdução da vacina

ABSTRACT Objective: To assess the number of cases and the profile of hospitalizations from varicella after the introduction of the measles, mumps, rubella and varicella combination vaccine in the public health system. Methods: Retrospective study in an infectious diseases pediatric hospital of reference in Southeast Brazil. The cases with a clinical diagnosis of varicella, from January 2011 to June 2016, were assessed from pediatricians' medical records. The hospitalizations were classified into a pre-vaccine group and post-vaccine group, based on the date the vaccine was introduced (September 2013). Both groups were compared by age, sex, time of hospitalization, reason for hospitalization, hospital complications, duration of intensive care, and clinical outcome. Results: A total of 830 hospitalizations were recorded; 543 in the pre-vaccine period and 287 in the post-vaccine period, a reduction of 47.1% (p<0.001). In both periods, a similar profile in the hospitalizations was noticed: majority male; aged between one to five years old; most complications due to secondary causes (mainly skin infections); main outcome was clinical improvement and discharge from the hospital. In the pre-vaccine period, six deaths were recorded and two were recorded in the post-vaccine period. Conclusions: The profile of the hospitalizations was expected to stay the same since this study did not compare vaccinated with unvaccinated children, but hospitalizations before and after the vaccine was introduced. In accordance with the medical literature, we found a significant fall in the number of hospitalizations from varicella.

RESUMO Objetivo: Avaliar o número de casos e o perfil das internações por varicela após a introdução da vacina quádrupla viral na rede pública. Métodos: Estudo retrospectivo conduzido em hospital pediátrico referência em doenças infectocontagiosas na Região Sudeste do Brasil. Foram avaliados os casos com diagnóstico clínico de varicela, registrados em prontuário por médico pediatra, de janeiro de 2011 até junho de 2016. As internações foram classificadas em grupo pré-vacinal e grupo pós-vacinal, com base na data de introdução da vacina (setembro de 2013). Os grupos foram comparados em relação a: faixa etária, sexo, tempo de hospitalização, causas da internação, complicações hospitalares, tempo da internação em terapia intensiva e desfecho clínico. Resultados: Foram documentadas 830 internações, 543 no período pré-vacinal e 287 no pós-vacinal, ocorrendo redução de 47,1% nas internações (p<0,001). Em ambos os períodos, notou-se um perfil similar das internações, predominantemente: sexo masculino; faixa etária de um a cinco anos; por causas secundárias (principalmente infecções de pele); evoluindo com melhora clínica e alta hospitalar. Em relação ao número de óbitos, ocorreram seis no período pré-vacinal e dois no pós-vacinal. Conclusões: A manutenção do perfil das internações era esperada, visto que o trabalho não comparou crianças vacinadas com não vacinadas, e sim internações pré e pós-vacinais. Observou-se, em concordância com a literatura, queda substancial no número de internações por varicela.

Asociación entre incidencia de varicela y variabilidad climática en la provincia de Tucumán, Argentina, 2005-2019 / Association between varicella incidence and climate variability in Tucumán province, Argentina, 2005-2019

INTRODUCTION: Varicella is a vaccine-preventable disease with marked seasonality. Few studies incorporate climatic variables to understand the epidemiological characteristics of this disease. The aim was to evaluate the relationship between varicella incidence and climatic variables in Tucumán (a province with temperate subtropical climate) during 2005-2019. METHODS: The relationship in pre- (2005-2014) and post-vaccination (2015-2019) periods was analyzed, identifying the associated climatic variables and the cut-off point where the risk of transmission increased. An observational ecological study was carried out with secondary data sources. R software was used. The information was split into three time series: 2005-2009, 2010-2014 and 2015-2019. For each period, a description of the time series was performed and generalized additive models (GAMs) were built using a negative binomial distribution. RESULTS: A seasonal behavior was observed, with peak incidence during spring in all periods. In the post-vaccination period, the peak occurred later (epidemiological week [EW] 46) than in the pre-vaccination periods (EW 43 and 42). Maximum temperature and relative humidity were associated during the first two periods, while minimum temperature, wind and thermal amplitude were associated in the third one. DISCUSSION: This study helped establish the relationship between climatic variables and varicella in Tucumán.

Herpes zóster en lactantes. Presentación de tres casos / Herpes zoster in infants. Three cases report

RESUMEN El herpes zóster es una afección infrecuente en lactantes, con una incidencia de 0,74/1 000 habitantes. Se produce por la reactivación del virus de la varicela zóster, tras una primoinfección por varicela. Puede ocurrir intraútero, por lo que resulta relevante conocer los antecedentes maternos. El diagnóstico es clínico y si se realiza de forma adecuada reduce el riesgo de complicaciones. El tratamiento en los niños es sintomático, porque su evolución es más favorable que en los adultos. Debido a la rareza de esta entidad, se presentan tres casos de herpes zóster en lactantes de 4, 6 y 11 meses de edad, que acudieron con lesiones y evolución típica de esta enfermedad al Hospital Pediátrico Provincial Docente Eliseo Noel Caamaño, de Matanzas, entre septiembre y octubre de 2017 (AU).

ABSTRACT Herpes zoster is an uncommon affection in infants, with an incidence of 0.74/1 000 inhabitants. It is produced by the reactivation of the varicella-zoster virus, after a primary infection by varicella. This can occur inside the uterus, making it relevant to know maternal antecedents. The diagnosis is clinical, and if it is made in an appropriate way, reduces complication risk. The treatment in children is symptomatic because its evolution is more favorable than in adults. Due to the rareness of this entity, we present three cases of herpes zoster in nurslings aged 4, 6 and 11 moths who assisted the Teaching Pediatric Hospital Eliseo Noel Caamaño, of Matanzas, with lesions and typical evolution of this disease in the period September-October 2017 (AU).

Incorporación de segunda dosis de la vacuna de la varicela al Calendario Nacional de Vacunación de Argentina / Incorporation of the second dose of the varicella vaccine to the national vaccination schedule of Argentina

A partir de 2022, a la dosis de vacuna contra la varicela contemplada a los 15 meses de edad en el Calendario Nacional de Vacunación de Argentina, se suma una segunda dosis al ingreso escolar. En este artículo se repasan los aspectos clave para la implementación de esta práctica de inmunización universal, gratuita y obligatoria. (AU)

Starting in 2022, a second dose of the varicella vaccine will be added to the 15-month-old dose included in Argentina's National Vaccination Schedule at school entry. This article reviews the key aspects for the implementation of this universal, free and mandatory immunization practice. (AU)