Zika Virus Infects Human Placental Mast Cells and the HMC-1 Cell Line, and Triggers Degranulation, Cytokine Release and Ultrastructural Changes.

Zika virus (ZIKV) is an emergent arthropod-borne virus whose outbreak in Brazil has brought major public health problems. Infected individuals have different symptoms, including rash and pruritus, which can be relieved by the administration of antiallergics. In the case of pregnant women, ZIKV can cross the placenta and infect the fetus leading to congenital defects. We have identified that mast cells in the placentae of patients who had Zika during pregnancy can be infected. This led to our investigation on the possible role of mast cells during a ZIKV infection, using the HMC-1 cell line. We analyzed their permissiveness to infection, release of mediators and ultrastructural changes. Flow cytometry detection of ZIKV-NS1 expression 24 h post infection in 45.3% of cells showed that HMC-1 cells are permissive to ZIKV infection. Following infection, ß-hexosaminidase was measured in the supernatant of the cells with a notable release at 30 min. In addition, an increase in TNF-α, IL-6, IL-10 and VEGF levels were measured at 6 h and 24 h post infection. Lastly, different intracellular changes were observed in an ultrastructural analysis of infected cells. Our findings suggest that mast cells may represent an important source of mediators that can activate other immune cell types during a ZIKV infection, which has the potential to be a major contributor in the spread of the virus in cases of vertical transmission.

Pneumonia por toxoplasmose em paciente imunocompetente / Toxoplasma pneumonia in an immunocompetent patient: case repor

Com grande distribuição mundial e incidência significativa, a toxoplamose é uma doença comum em mamíferos e pássaros, causada pelo protozoário Toxoplasma gondii. No homem, o parasitismo na fase proliferativa intracelular pode se apresentar sem sintomas, ou causar clínica transitória caracterizada por febre, fadiga e linfadenopatia. Por se tratar de patologia com sintomas inespecíficos e comuns a muitas outras, é fundamental a correta pesquisa de diagnósticos diferenciais, como citomegalovírus e Epstein-Barr. Relatamos o caso de um jovem e hígido, que desenvolveu pneumonia e, após confirmação sorológica para toxoplasmose e o tratamento adequado, apresentou melhora clínica.

With great worldwide distribution and significant incidence, toxoplamosis is a common disease in mammals and birds, caused by the protozoan Toxoplasma gondii. In humans, the parasitism in its intracellular proliferative phase may present no symptoms, or cause a transient condition characterized by fever, fatigue, and lymphadenopathy. Because it is a pathology with nonspecific symptoms that are common to many other conditions, it is fundamental to find the correct research of differential diagnoses, such as for Cytomegalovirus and Epstein Barr. We report a case of a young and healthy man who developed pneumonia and, after serological confirmation for toxoplasmosis and the appropriate treatment, presented clinical improvement

Aminotransferase changes and acute hepatitis in patients with dengue fever: analysis of 1,585 cases.

INTRODUCTION: Type 3 dengue virus caused an extensive epidemic in the state of Rio de Janeiro in summer 2002. In some of the patients, it was found in an atypical form with increased aminotransferase levels and acute hepatitis. MATERIAL AND METHODS: An analysis was made of 1,585 serologically confirmed dengue cases at the Dengue Reference Center in Campos dos Goytacazes, Rio de Janeiro state. The grade of hepatic aggression was established according to the alterations in the aminotransferase levels: grade A -- normal levels of aminotransferase; grade B -- elevated aminotransferase, with increased levels of at least one of the enzymes; grade C -- elevated aminotransferase, with the levels of at least one of the enzymes increased to more than three times the reference values; grade D -- acute hepatitis, with aminotransferase levels increased to at least 10 times their normal values. RESULTS: Among the 1,585 serologically confirmed dengue cases, 44.5% presented alterations in the aminotransferase levels (grade B), 16.9% presented grade C liver involvement and 3.8% of the patients had progressed to acute hepatitis (grade D). The average values for the rise in aspartate aminotransferase and alanine aminotransferase were 93.3 U/L and 86.0 U/L. The greatest alterations were observed among females (p<0.001), cases of dengue hemorrhagic fever (p<0.001), and cases with sequential infections (p=0.001). CONCLUSIONS: Liver damage with elevation of aminotransferases and reactive hepatitis was a common complication of dengue virus infection in these patients.

Paciente com Chikungunya evoluindo com Síndrome de Angústia Respiratória do Adulto grave / Chikungunya evolving with SRDA Chikungunya patient progressing to severe Adult Respiratory Distress Syndrome

Objetivo: Demonstrar casos de Chikungunya cujos paciente evoluíram com Síndrome da Angústia Respiratória do Adulto. Métodos: Estudo descritivo e documental cuja a amostra foi composta por pacientes internados em um hospital no município de Campos dos Goytacazes, diagnosticados com sorologia IgM positiva para febre do vírus Chikungunya, que evoluíram para Síndrome da Angústia Respiratória do Adulto. Foram feitas análises de prontuários e de imagens radiológicas, além de revisão de literatura. Resultados: Foram incluídos três pacientes no estudo, sendo que um evoluiu ao óbito e os outros dois obtiveram recuperação de suas funções após o quadro agudo da doença. Conclusão: A Chikungunya é uma doença recente em território nacional, com possível evolução para quadros graves, especialmente em sua fase aguda. Por essa razão, estudos aprofundados são necessários para maior conhecimento e entendimento da patologia e de suas factíveis complicações.

Objective: To report cases of Chikungunya that progressed with Acute Respiratory Distress Syndrome. Methods: This is a descriptive and documental study, the sample of which consisted of patients who were hospitalized, in the city of Campos dos Goytacazes, diagnosed with positive IgM serology for Chikungunya fever, which progressed to Acute Respiratory Distress Syndrome. Medical records and radiological images were analyzed, and literature reviewed. Results: Three patients were included in the study, with one of them progressing to death, and the other two having their functions recovered after acute illness. Conclusion: Chikungunya is a recent disease in the national territory, with possible progression to severe conditions, especially on its acute phase. For this reason, in-depth studies are necessary for a better knowledge and understanding of the pathology and its likely complications

Perfil epidemiológico dos pacientes com evolução subaguda e crônica de infecção por Chikungunya / Epidemiologic profile of patients with subacute and chronic Chikungunya infection evolution

OBJETIVO: Analisar o perfil epidemiológico dos pacientes com evolução subaguda e crônica da infecção por Chikungunya, e avaliar suas principais alterações laboratoriais. MÉTODOS: Estudo observacional, realizado por meio da análise de 31 prontuários de pacientes atendidos em um centro de referência de doenças imunoinfecciosas, no Estado do Rio de Janeiro, no período de janeiro a maio de 2016. Foram selecionados prontuários de pacientes com Chikungunya em fase subaguda ou crônica com diagnóstico confirmado por sorologia IgM, de ambos os sexos e de todas as faixas etárias. As seguintes variáveis foram consideradas: sexo, idade, leucócitos, plaquetas, velocidade de hemossedimentação, e aspartato aminotransferases e alanina transaminase (AST/ALT). RESULTADOS: A faixa etária predominante foi de 50 a 69 anos (64,5%). Pertenciam ao sexo feminino 83,9% dos pacientes. Dentre as alterações laboratoriais, destacaram-se elevação da velocidade de hemossedimentação (46,15%), leucopenia (37%), elevação de transaminases (30,8% AST e 23% ALT) e trombocitopenia (11,1%). CONCLUSÃO: Observou-se a importância epidemiológica na determinação de pacientes potencialmente capazes de desenvolver tais sequelas, representada principalmente pela artralgia incapacitante. A identificação desse grupo, caracterizado como pacientes do sexo feminino e de faixa etária entre 50 e 69 anos, pode ser de grande valia para a prevenção da evolução mórbida dessa arbovirose, sabendo que tais pacientes necessitam de cuidados especiais e acompanhamento clínico mais rigoroso.(AU)

OBJECTIVES: To analyze the epidemiological profile of patients with subacute and chronic Chikungunya infection, and to evaluate their main laboratory abnormalities. METHODS: This is an observational study, carried out through the analysis of 31 medical records of patients attended at a Reference Center for Immunopathological Diseases in the state of Rio de Janeiro, from January to May 2016. Patients with Chikungunya were selected in the subacute or chronic phase with diagnosis confirmed by IgM serology; both genders and all age ranges. The following variables were considered: gender, age, leukocytes, platelets, erythrocyte sedimentation rate, and aspartate aminotransferases and alanine transaminase (ASTALT). RESULTS: The predominant age range was 50 to 69 years (64.5%), with 83.9% of the patients being female. Among the laboratory alterations, high erythrocyte sedimentation rate (46.15%), leukopenia (37%), high transaminases (30.8% AST, and 23% ALT), and thrombocytopenia (11.1%) were observed. CONCLUSIONS: The epidemiological importance in the determination of patients potentially capable of developing such sequels, represented mainly by incapacitating arthralgia, was observed. The identification of this group, characterized as female patients, and between 50 and 69 years of age, may be of great value in the prevention of the morbid progression of this arbovirosis, knowing that such patients require special care, and stricter clinical follow-up.(AU)

Comparison of clinical and laboratory characteristics between children and adults with dengue.

Over the past several years, the epidemiological profile of dengue has been changing progressively and is currently characterized by an increase in the number of cases in children under 15 years of age. This study was aimed at comparing the clinical and laboratory features between adults and children with dengue; therefore, we performed a cross-sectional analysis of 5686 individuals with laboratory-confirmed dengue who sought treatment at a healthcare facility in Rio de Janeiro, Brazil from 2010 to 2011. A multivariate analysis indicated that myalgia (OR=2.58; CI 95%=2.08-3.18), retro-orbital pain (OR=1.36; CI 95%=1.15-1.62), nausea (OR=1.92; CI 95%=1.60-2.30), and arthralgia (OR=3.64; CI 95%=2.72-4.89) were the most frequent clinical symptoms in adults, whereas vomiting (OR=0.52; CI 95%=0.43-0.61) and skin rash (OR=0.46; CI 95%=0.25-0.85) were the most prevalent symptoms in children. Adults exhibited a higher hemoconcentration (OR=3.04; CI 95%=2.53-3.65), thrombocytopenia (OR=2.17; CI 95%=1.80-2.60), increased erythrocyte sedimentation rate (OR=1.81; CI 95%=1.53-2.14), and increased ALT (OR=3.13; CI 95%=2.44-4.02) than did children. In addition, adults exhibited a higher frequency of the severe forms of the disease (OR=1.74; CI 95%=1.12-2.72) and hospitalization (OR=2.21; CI 95%=1.59-3.06) relative to children. Based on these results, this study demonstrated significant differences in the clinical and laboratory presentations and disease severity between adults and children affected by dengue.

Acometimento visceral e ocular simultâneo em infecção por toxocara canis acompanhado de farmacodermia / Concurrent visceral and ocular involvementin toxocara canis infection and pharmacodermia

A toxocaríase humana é uma infecção parasitária de distribuição mundial causada pelos nematelmintos das espécies Toxocara canis e Toxocara cati, presentes no intestino do cão e do gato, respectivamente. Clinicamente, na maioria das vezes, é assintomática, porém pode apresentar-se de duas formas: visceral ou ocular. Visceralmente, gera uma síndrome hipereosinofílica crônica, acompanhada por leucocitose e hepatomegalia, podendo ocorrer algum grau de infiltrado pulmonar e febre. Na toxocaríase ocular, ocorre uveite intermediária ou posterior, podendo haver formação de granuloma, geralmente unilateral. O acometimento misto é raro, o que motivou este relato. Trata-se de paciente de 19 anos, sexo masculino, que apresentou como sintoma inicial perda da acuidade visual em olho esquerdo. Recebeu tratamento, sem melhora, com sulfametoxazol + trimetoprima e corticoide, fazendo farmacodermia. Evoluiu com diarreia, febre, dor abdominal e hepatoesplenomegalia. Descartadas infecções agudas por toxoplasmose, sífilis, vírus da imunodeficiência humana (HIV), citomegalovirose e dengue; apresentou leucocitose com hipereosinofilia. Foi solicitada sorologia para toxocaríase, confirmando esta infecção. Após o tratamento, apresentou completa remissão dos sintomas. O objetivo aqui foi debater os fatores confundidores, diagnósticos diferenciais, necessidade de exames complementares específicos e conduta terapêutica, de acordo com o quadro clínico.(AU)

Human toxocariasis is a worldwide parasitic infection caused by ascarid nematodes species: Toxocara canis and Toxocara cati, that are present in the intestines of dogs and cats, respectively. Although clinically, most human infections are asymptomatic, two syndromes of human toxocariasis are recognized: visceral and ocular. The visceral form is a hypereosinophilic syndrome accompanied by leukocytosis, hepatomegaly, some degree of pulmonary infiltrate and fever. In ocular toxacariasis there is intermediate or posterior uveitis, and there may be granuloma formation, usually unilateral. The simultaneous involvement of the two forms is rare, which is what, motivated this report. It is a 19-year-old male patient who initially presented loss of visual acuity in the left eye. He received treatment, without improvement, with sulfamethoxazole-trimethoprim and corticoid, causing a pharmacodermia. He developed diarrhea, fever, abdominal pain and hepatosplenomegaly. It was discarded acute infections by toxoplasmosis, syphilis, human immunodeficiency virus (HIV), cytomegalovirus and dengue. The patient also manifested leukocytosis with hypereosinophilia. Serological testing for toxacariasis was requested, diagnosing the infection. After treatment, he progressed with full symptoms remission. The aim of this study was to discuss confounding factors, differential diagnoses, the need for specific complementary exams and therapeutic management, according to the clinical aspects.(AU)

Clinical and hepatic evaluation in adult dengue patients: a prospective two-month cohort study.

INTRODUCTION: To analyze the liver dysfunction and evolution of signs and symptoms in adult dengue patients during a two-month follow-up period. METHODS: A prospective cohort study was conducted in Campos dos Goytacazes, Rio de Janeiro, Brazil, from January to July, 2008. The evolution of laboratory and clinical manifestations of 90 adult dengue patients was evaluated in five scheduled visits within a two-month follow-up period. Twenty controls were enrolled for the analysis of liver function. Patients with hepatitis B, hepatitis C, those known to be human immunodeficiency virus (HIV) seropositive and pregnant women were excluded from the study. RESULTS: At the end of the second month following diagnosis, we observed that symptoms persisted in 33.3% (30/90) of dengue patients. We also observed that, 57.7% (15/26) of the symptoms persisted at the end of the second month. The most persistent symptoms were arthralgia, fatigue, weakness, adynamia, anorexia, taste alteration, and hair loss. Prior dengue virus (DENV) infection did not predispose patients to a longer duration of symptoms. Among hepatic functions, transaminases had the most remarkable elevation and in some cases remained elevated up to the second month after the disease onset. Alanine aminotransferase (ALT) levels overcame aspartate aminotransferase (AST) during the convalescent period. Male patients were more severely affected than females. CONCLUSIONS: Dengue fever may present a wide number of symptoms and elevated liver transaminases at the end of the second month.

Aminotransferases analysis in patients with dengue serotype IV / Análise das aminotransferases em pacientes com dengue sorotipo IV

OBJECTIVE: To evaluate the aminotransferase levels inpatients with dengue serotype IV. METHODS: We conducteda cross-sectional analysis of 3,596 people with laboratory confirmed dengue. RESULTS: The analysis showed that 49.2%(1,768) had normal aminotransferase levels, 43.4% (1,559)had changes in levels by up to three times the upper limit ofnormal, 7.0% (253) had elevations three times the referencevalue and 0.4% (16) developed acute hepatitis. Patients withthrombocytopenia and hemoconcentration had major changesin the levels of enzymes (p<0.05). Women were more susceptibleto those changes than men (p<0,05). The average AST and ALTwere higher in dengue hemorrhagic type (147.51±137.74U/Land 111.54±81.27U/L) as compared to dengue fever(55.18±52.06U/L and 60.39±57.50U/L) (p<0.05). Leukopenicpatients had aminotransferases average lower compared toindividuals without any drop in overall white blood cellcount (p<0.05). A total of 224 patients were submitted tohospitalization, with the AST average of 88.18±100.47U/Land ALT 77.95±88.38U/L, which is higher than the average inambulatory patients (p<0.05). CONCLUSION: A significantnumber of patients was found with altered levels of enzymes,which requires clinical laboratory monitoring for an extendedperiod.

OBJETIVO: Avaliar os níveis de aminotransferases em pacientes com dengue sorotipo IV. MÉTODOS: Foi realizada uma análise transversal de 3.596 pessoas com dengue confirmada laboratorialmente. RESULTADOS: A análise mostrou que49,2% (1.768) tinham níveis normais de aminotransferases,43,4% (1.559) mostraram alterações nos níveis em até três vezes o limite superior da normalidade, 7,0% (253) apresentaram elevações três vezes o valor de referência e 0,4% (16) desenvolveram hepatite aguda. Os doentes com trombocitopenia e hemoconcentração tiveram grandes alterações nos níveis enzimáticos(p<0,05). As mulheres foram mais suscetíveis a essas alterações do que os homens (p<0,05). As médias de AST e ALT foram maiores na dengue do tipo hemorrágica (147,51±137,74U/Le 111,54±81,27U/L) em comparação com dengue clássica(55,18±52,06U/L e 60,39±57,50U/L) (p<0,05). Pacientes leucopênicos tiveram a média de aminotransferases menor em comparação com os indivíduos sem qualquer queda na contagem global de glóbulos brancos (p<0,05). Um total de 224pacientes foi submetido a hospitalização, com a média de AST88,18±100,47U/L e ALT 77,95±88,38U/L, o que é mais elevado do que a média em doentes ambulatórios (p<0,05). CONCLUSÃO:Um número significativo de pacientes foi identificado com níveis alterados de enzimas, o que exige acompanhamento clínico e laboratorial por um período prolongado.

Polymyositis due to Toxoplasma gondii in an immunocompetentpatient / Polimiosite por Toxoplasma gondii em paciente imunocompetente

Toxoplasmosis is a worldwide zoonosis caused by the protozoan Toxoplasma gondii, which is mostly acquired by food contaminated with sporulated oocysts present in the feces of cats. The majority of patients evolve without symptoms, if immunocompetent. Its diagnosis is mainly clinical, confirmed by serological study. We report a rare occurrence of toxoplasmosis polymyositis in an immunocompetent patient, emphasing confounding factors, differential diagnoses, complementary tests and therapeutic management, according to the clinical picture.

A toxoplasmose é uma zoonose cosmopolita causada pelo protozoário Toxoplasma gondii, adquirida por alimentos contaminados com oocistos esporulados, presentes nas fezes de felinos. A maioria dos pacientes evolui de forma assintomática, principalmente os imunocompetentes. Possui diagnóstico principalmente clínico, confirmado pela sorologia. Descrevemos uma rara apresentação de polimiosite por toxoplasmose em paciente imunocompetente, enfatizando os fatores confundidores, diagnósticos diferenciais, exames complementares e conduta terapêutica, de acordo com o quadro clínico.

Acute acalculous cholecystitis in a teenager with hepatitis a virus infection: a case report.

Acute viral hepatitis A is a common systemic infection in children, especially in developing countries. Acute acalculous cholecystitis in the course of this infection is a rare and poorly reported event that needs to be diagnosed because of the possibility of complications, such as gangrene and perforation of the gallbladder wall. We present the case of a 16-year-old teenager with clinical and ultrasonographic findings of acalculous cholecystitis during an episode of hepatitis A virus infection, which took place December 2007 in Plantadores de Cana Hospital.

Perfil dos sinais e sintomas mais prevalentes na epidemia de dengue pelo sorotipo 4 em Campos dos Goytacazes (RJ) / Profile of signs and symptoms more prevalent in the epidemic of dengue serotype 4 in Campos dos Goytacazes (RJ)

JUSTIFICATIVA E OBJETIVO: O quadro clínico da dengue é composto por sinais e sintomas variáveis, dependendo de di- versos fatores, como a existência de quatro sorotipos virais. O objetivo deste estudo foi identificar os sinais e sintomas mais prevalentes durante a epidemia de dengue pelo sorotipo 4. MÉ- TODOS: Estudo observacional realizado por meio de análise de 600 prontuários de pacientes atendidos no Centro de Referência da Dengue em Campos (RJ), no período de janeiro a abril de 2013. Foram selecionados prontuários de pacientes de ambos os sexos, faixa etária superior a 13 anos de idade e com sorologia antidengue IgM reagente. As variáveis analisadas foram: faixa etária, sexo, sinais e sintomas apresentados no primeiro atendi- mento ambulatorial. RESULTADOS: Na amostra analisada, a faixa etária predominante foi de 41 a 60 anos (37,5%), seguida pela de 21 a 40 anos (36,7%). Pertenciam ao sexo feminino 61,5% dos pacientes. Dentre os sinais e sintomas, destacam-se febre (89,2%), cefaleia (82,2%), mialgia (79,8%) e dor retro- or bitária (60,5%). Outros sinais e sintomas foram observados em menor frequência: dor em membros inferiores (11,3%), dor lombar (10,2%), sinais hemorrágicos (6,5%) e parestesia em membros inferiores (1,5%). CONCLUSÕES: Sintomas como febre, cefaleia, mialgia e dor retro-orbitária permaneceram entre as manifestações mais comuns da doença. Sintomas incomuns estiveram presentes, mesmo que em menor proporção. Sinais hemorrágicos intensos e de insuficiência circulatória foram pou- co observados, mostrando o caráter mais brando da infecção por esse sorotipo viral.(AU)

BACKGROUND AND OBJECTIVE: The clinical manifestations of dengue is composed of signs and symptoms varying depending on several factors, such as the existence of four serotypes. The objective of this study was to identify the signs and symptoms more prevalent during the epidemic of dengue serotype 4. METHODS: This was an observational study through analysis of medical records of 600 patients seen at the Reference Center Dengue in Campos (RJ), Brazil, in the period from January to April 2013. Records of patients of both sexes, age greater than 13 years and with serology antidengue IgM reagent were selected. The variables analyzed were age, sex, signs and symptoms presented in the first outpatient care. RESULTS: In the sample analyzed, the predominant age group was 41-60 years (37.5%), followed by 21-40 years (36.7%); 61.5% were female. Fever (89.2%), headache (82.2%), myalgia (79.8%) and retro-orbital pain (60.5%) were the main signs and symptoms. Other signs and symptoms were observed less frequently: pain in the lower limbs (11,3 %), low back pain (10,2 %), signs bleeding (6,5 %) and paresthesia in the lower limbs (1,5 %). CONCLUSION: Symptoms such as fever, headache, myalgia and retro-orbital pain remained among the most common manifestations of the disease. Unusual symptoms were present, even in a smaller proportion. Intense bleeding and signs of circulatory failure were little observed, showing the softer character of infection by this serotype.(AU)

Alteration in the erythrocyte sedimentation rate in dengue patients: analysis of 1,398 cases.

A study of the erythrocyte sedimentation rate during the first hour (ESR) in dengue patients would help determine how this parameter is affected by this disease, as well as whether it can be used for diagnosis. One thousand, three hundred and ninety-eight cases of dengue attended at the Dengue Treatment Center, Campos dos Goytacazes Rio de Janeiro, Brazil, were included. The ESR values were classified as normal or elevated and compared by gender and clinical form of the disease. Among the 1,398 cases ESR was normal in 81.25% (n = 1,136), while in 18.75% (n=262) it was elevated. In 83.92% (n=514) of the male dengue patients ESR was normal, while in 16.08% (n=98) it was elevated. Among female dengue patients, 79.17% (n=622) had normal ESR, and in 20.83% (n=164) ESR was elevated (p=0.05). Among patients with classic dengue, 77.28% (n=961) had normal ESR, while in 22.72% (n=282), it was elevated. Also in 85.81% (n=133) of patients with hemorrhagic dengue, ESR was normal, while in 14.19% (n=22) ESR was elevated (p=0.026). We concluded that ESR was within normal ranges in most dengue cases, independent of gender or clinical presentation. Given the high frequency of normality and the ease of determination of this parameter, ESR data can help in the differential diagnosis of dengue.

Comparison of clinical and laboratory characteristics between children and adults with dengue

Over the past several years, the epidemiological profile of dengue has been changing progressively and is currently characterized by an increase in the number of cases in children under 15 years of age. This study was aimed at comparing the clinical and laboratory features between adults and children with dengue; therefore, we performed a cross-sectional analysis of 5686 individuals with laboratory-confirmed dengue who sought treatment at a healthcare facility in Rio de Janeiro, Brazil from 2010 to 2011. A multivariate analysis indicated that myalgia (OR = 2.58; CI 95% = 2.08-3.18), retro-orbital pain (OR = 1.36; CI 95% = 1.15-1.62), nausea (OR = 1.92; CI 95% = 1.60-2.30), and arthralgia (OR = 3.64; CI 95% = 2.72-4.89) were the most frequent clinical symptoms in adults, whereas vomiting (OR = 0.52; CI 95% = 0.43-0.61) and skin rash (OR = 0.46; CI 95% = 0.25-0.85) were the most prevalent symptoms in children. Adults exhibited a higher hemoconcentration (OR = 3.04; CI 95% = 2.53-3.65), thrombocytopenia (OR = 2.17; CI 95% = 1.80-2.60), increased erythrocyte sedimentation rate (OR = 1.81; CI 95% = 1.53-2.14), and increased ALT (OR = 3.13; CI 95% = 2.44-4.02) than did children. In addition, adults exhibited a higher frequency of the severe forms of the disease (OR = 1.74; CI 95% = 1.12-2.72) and hospitalization (OR = 2.21; CI 95% = 1.59-3.06) relative to children. Based on these results, this study demonstrated significant differences in the clinical and laboratory presentations and disease severity between adults and children affected by dengue.

Cirrose hepática em adolescente com hepatite autoimune: relatode caso / Cirrhosis of the liver in adolescents with autoimmune hepatitis: case report

JUSTIFICATIVA E OBJETIVOS: A hepatite autoimune (HAI) é uma doença inflamatória do fígado de etiologia ainda desconhecida, que cursa com destruição progressiva do parênquima hepático e evolui frequentemente para cirrose, na ausência de tratamento imunossupressor. Caracteriza-se pela presença de autoanticorpos,hipergamaglobulinemia e disfunção hepática. O objetivo deste estudo foi demonstrar que o diagnóstico precoce e tratamento adequado na hepatite autoimune são essenciais na redução de possíveis morbidades relacionadas à presença desta doença.RELATO DO CASO: Paciente do sexo feminino, 11 anos, estudante, natural de Campos dos Goytacazes, foi admitida no Centro de Referência da Dengue com quadro de febre, vômitos aquosos, cefaleia frontal e icterícia. Ao exame constatou-se ascite, esplenomegalia, petéquias e edemas nos membros inferiores. O diagnóstico de hepatite autoimune foi firmado pela exclusão de outras causas de hepatopatias e pela presença de variáveis clínicas,laboratoriais e histológicas características da doença. Assim, o tratamento foi realizado com prednisona seguido de azatioprina,com boa resposta.CONCLUSÃO: A HAI, apesar de rara, deve ser lembrada como diagnóstico diferencial de outras afecções para que o tratamento correto seja instituído precocemente. Dessa forma, objetivando controlar a doença, melhorar a sobrevida e evitar suas possíveis complicações.

BACKGROUND AND OBJECTIVES: Autoimmune hepatitis (AIH) is an inflammatory disease of the liver of unknown etiology that leads to progressive destruction of the parenchyma and often progresses to cirrhosis in the absence of immunosuppressive treatment. It is characterized by the presence of autoantibodies, hypergammaglobulinemia and liver dysfunction. The aim of this study was to demonstrate that early diagnosis and appropriate treatment in autoimmune hepatitis are essential in reducing potential health problems related to this disease.CASE REPORT: Female patient, 11 years-old, student, who borned in Campos of Goytacazes and was admitted in the Reference Center of Dengue with fever, watery vomiting, headache and jaundice. On examination it was found ascites, splenomegaly,flapping, petechiae and edema of lower limbs. The diagnosis of autoimmune hepatitis was confirmed by excluding other causes of liver disease and the presence of clinical, laboratory and histological characteristic of disease. The patient was treated with prednisone followed by azathioprine, with good response.CONCLUSION: AIH, although rare, must be considered as a differential diagnosis of other diseases for which proper treatment instituted early. Thus, aiming to control the disease, improve survival and prevent its complications.

Polineuroradiculopatia por citomegalovírus em paciente imunocompetente: relato de caso / Cytomegalovirus is polyradiculoneuropathy in an immunocompetent patient: case report

JUSTIFICATIVA E OBJETIVOS: A citomegalovirose é uma infecção causada pelo citomegalovírus (CMV) e, quando manifestada clinicamente, produz sintomas leves em indivíduos imunocompetentes.As complicações durante o curso da infecção estão geralmente relacionadas a situações de imunodeficiência. O objetivo deste estudo foi relatar um caso raro de polirradiculoneuropatia por CMV em adolescente previamente hígida sem relação com imunodeficiência. RELATO DO CASO: Paciente do sexo feminino, 13 anos, imunocompetente,apresentou quadro inicial de cefaleia, febre, mialgia e artralgia, evoluindo com queixa de mialgia cervical, parestesia de mãos e pés e fraqueza muscular que dificultava a deambulação. A eletroneuromiografia evidenciou sinais compatíveis com miopatia neurogênica, sugerindo um quadro de polirradiculoneuropatia desmielinizante.Foram realizadas sorologias para CMV, confirmando o diagnóstico etiológico. CONCLUSÃO: A polirradiculoneuropatia por CMV não associada à síndrome da imunodeficiência adquirida (SIDA) ou outras imunodeficiências é uma complicação esperada, porém rara da infecção por este vírus, não necessitando de nenhum tratamento específico à medida que o acometimento neurológico seja autolimitado. O acompanhamento clínico rigoroso se faz necessário, já que se trata de uma entidade de evolução imprevisível, dependente da resposta imunológica de cada hospedeiro.

BACKGROUND AND OBJECTIVES: Cytomegalovirus (CMV) infection is caused by CMV and when manifested clinically produces mild symptoms in immunocompetent individuals. Complications during the course of infection are usually related to situations of immunodeficiency. The aim of this study was to report a rare case of CMV polyradiculoneuropathy in previously healthy teen ager with no relation to immunodeficiency. CASE REPORT: Female patient, 13 years old, immunocompetent,presented the initial headache, fever, myalgia and arthralgia, myalgia progressing with complaints of neck, numbness of hands and feet,and muscle weakness that impair ambulation. Electromyography showed signs compatible with neurogenic myopathy, suggesting a picture of demyelinating polyradiculoneuropathy. CMV serology was performed, confirming the diagnosis. CONCLUSION: The cytomegalovirus' polyradiculoneuropathy not associated with acquired immunodeficiency syndrome (AIDS) or other immunodeficiency's is an expected complication but rare infection by this virus does not require any specific treatment as the neurological involvement is self-limited. The strict clinical monitoring is necessary, since it is an entity of unforeseeable change, dependent on the immune response of each host.

Clinical and hepatic evaluation in adult dengue patients: a prospective two-month cohort study / Avaliação das alterações clínicas e hepáticas em pacientes adultos com dengue: estudo prospectivo em um período de dois meses

INTRODUCTION: To analyze the liver dysfunction and evolution of signs and symptoms in adult dengue patients during a two-month follow-up period. METHODS: A prospective cohort study was conducted in Campos dos Goytacazes, Rio de Janeiro, Brazil, from January to July, 2008. The evolution of laboratory and clinical manifestations of 90 adult dengue patients was evaluated in five scheduled visits within a two-month follow-up period. Twenty controls were enrolled for the analysis of liver function. Patients with hepatitis B, hepatitis C, those known to be human immunodeficiency virus (HIV) seropositive and pregnant women were excluded from the study. RESULTS: At the end of the second month following diagnosis, we observed that symptoms persisted in 33.3% (30/90) of dengue patients. We also observed that, 57.7% (15/26) of the symptoms persisted at the end of the second month. The most persistent symptoms were arthralgia, fatigue, weakness, adynamia, anorexia, taste alteration, and hair loss. Prior dengue virus (DENV) infection did not predispose patients to a longer duration of symptoms. Among hepatic functions, transaminases had the most remarkable elevation and in some cases remained elevated up to the second month after the disease onset. Alanine aminotransferase (ALT) levels overcame aspartate aminotransferase (AST) during the convalescent period. Male patients were more severely affected than females. CONCLUSIONS: Dengue fever may present a wide number of symptoms and elevated liver transaminases at the end of the second month.

INTRODUÇÃO: Analisar prospectivamente a disfunção hepática e a evolução dos sinais e sintomas em pacientes adultos com dengue durante um período de dois meses. MÉTODOS: Realizamos um estudo prospectivo em Campos dos Goytacazes, Rio de Janeiro, Brasil, de janeiro a julho de 2008. Foi avaliada a evolução das manifestações clínicas e laboratoriais em 90 pacientes adultos com dengue, em um período de dois meses. Vinte controles foram arrolados para análise da função hepática. Em ambos os grupos foram realizadas coletas de dados e sangue nos primeiros cinco dias da doença, e aos 8, 15, 30 e 60 dias após o início da doença. Foram excluídos pacientes com hepatite B, hepatite C, gestantes e aqueles sabidamente soropositivos para HIV. RESULTADOS: No final do segundo mês do início da dengue, 33,3% (30/90) dos pacientes apresentaram persistência de pelo menos um sinal ou sintoma. Estavam presentes no final do segundo mês 57,7% (15/26) dos sinais ou sintomas. Os maiores percentuais de persistência foram: artralgia, adinamia, fraqueza, fadiga, anorexia, alteração do paladar e queda de cabelo. A infecção prévia pelo vírus da dengue (DENV) não predispôs a uma maior duração dos sintomas. Da função hepática, observamos alterações relevantes somente nos níveis das transaminases, que em alguns casos permaneceram elevados até o final do segundo mês. Os níveis de ALT ultrapassaram os de AST na convalescença. Homens apresentaram níveis mais elevados de transaminases quando comparados aos de mulheres. CONCLUSÕES: Dengue apresenta grande número de sintomas e transaminases elevadas no final do segundo mês de doença.

Colecistite alitiásica por dengue: relato de casos / Acalculous cholecystitis in dengue: case reports

JUSTIFICATIVA E OBJETIVOS: Destacar a importância de investigar a colecistite alitiásica em pacientes com dengue, que tenham dor abdominal como sinal de alerta, através da exposição de dois casos diagnosticados no Cento de Referência da Dengue (CRD) no município de Campos dos Goytacazes no primeiro semestre de 2007. RELATO DOS CASOS: Dois pacientes encaminhados ao CRD com quadro clínico de dengue foram submetidos à anamnese, exame físico, rotina laboratorial na admissão e em decorrência de importante queixa álgica abdominal, foi realizada ultrassonografia dessa região. As ultrassonografias, em ambos os casos, evidenciaram vesícula biliar distendida com paredes difusamente espessadas, sem evidências ou sinais de litíase em seu interior (colecistite alitiásica). A pesquisa IgM para dengue foi realizada no 8º dia após o inicio do quadro e confirmou a suspeita clínica inicial. CONCLUSÃO: A colecistite alitiásica é uma manifestação atípica da dengue, normalmente autolimitada, que deve ser pesquisada em todos os pacientes que tenham dor abdominal (como sinal de alerta) e a conduta adequada restringese ao tratamento de suporte, devendo a cirurgia ser reservada às complicações.

BACKGROUND AND OBJECTIVES: Attests the importance of the acalculous cholecystitis investigation in dengue fever patients who present abdominal pain as an alert sign. The article is based on two case reports diagnosed at the Dengue Reference Center (DRC) in the municipality of Campos do Goytacazes in the first half severing of 2007. CASE REPORT: Two patients sent to DRC suspected of having dengue fever were evaluated for a medical history, and subjected to physical examination and routine laboratory tests on admission and were given abdominal ultrasound when they presented with abdominal pain. The ultrasound findings were that the gallbladder wall was diffusely thickened with no evidence or signs of litiase in its interior (acalculous cholecystitis). The serological IgM proved that it was dengue fever on the eighth day after the first symptom. CONCLUSION: The acalculous cholecystitis is an atypical manifestation of dengue fever. It is usually auto-limited, and has to be researched in all patients with abdominal pain as an alert sign. The appropriate conduct is support treatment, and surgical treatment may be reserved only for complications.

Velocidade de hemossedimentação na dengue: rastreio eprognóstico / Erythrocyte sedimentation rate: screening and prognosis.

JUSTIFICATIVA E OBJETIVOS: A dengue é um dos principais problemas de saúde pública no mundo, cujo espectro clínico varia desde formas assintomáticas até quadros potencialmente fatais. A velocidade de hemossedimentação (VHS) vem sendo utilizada no diagnóstico diferencial dessa doença e na avaliação prognóstica desses pacientes. O objetivo deste estudo foi avaliar a utilização da VHS na abordagem dos casos suspeitos de dengue; determinar sua acurácia no rastreio da doença e avaliar sua associação com casos mais graves. MÉTODO: Realizou-se um estudo observacional analítico transversal, em que 562 pacientes com diagnóstico sorológico de dengue e 500 sem esse diagnóstico tiveram os níveis de VHS avaliados. RESULTADOS: Nos pacientes com dengue, o valor da VHS foi normal em 68% (352) dos casos. A média de VHS nesse grupo foi 13,7 mm/h (4-95). Dentre os pacientes com febre hemorrágica da dengue (FHD), 91% (61) tiveram VHS normal e a média foi de 9,2 mm/h (4-44). Já nos pacientes sem diagnóstico de dengue, a média de VHS encontrada foi de 21,9 mm/h (5-110) e 59,4% (297) apresentou VHS normal. CONCLUSÃO: A VHS encontra-se abaixo do referencial em grande parte dos pacientes com dengue, principalmente nas formas hemorrágicas. Sugere-se, então, que este teste seja solicitado em casos suspeitos de dengue, por ser de baixo custo e com boa correlação diagnóstica e prognóstica.