Clinical laboratory and dispersion pattern of COVID-19 in a family cluster in the social-distancing period.

INTRODUCTION: Since the first reports of coronavirus disease 2019 (COVID-19) in December 2019, the disease has spread worldwide. Different social isolation strategies have been adopted to reduce community transmission, but few studies have evaluated the pattern of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection in a family cluster during periods of isolation. We report an outbreak in 24 members of a family cluster during a period of social distancing. METHODOLOGY: We carried out an observational descriptive study of a family cluster infected with SARS-CoV-2 in Pernambuco, Northeast Brazil. Laboratory confirmation included RT-PCR of nasopharyngeal samples or IgM or IgG serology. RESULTS: The attack rates were 75% (19/24) based on laboratory-confirmed cases and 87.5% (21/24) including probable cases. The time of spread was 17 days from the first case. All patients had mild symptoms, requiring no hospitalization, and none of them died. The frequency of symptomatic, laboratory-confirmed patients was higher among adults (94%) than among children (50%); the paediatric age group also had a higher frequency of exposed individuals who remained negative for infection. Ground-glass opacities on chest computed tomography were present in all patients with reported dyspnoea. CONCLUSION: This study highlights a high risk of intrahousehold transmission from an index case, suggesting the need for (I) specific guidelines during periods of social distancing, (II) minimization of external exposures and, above all, (III) adoption of strict quarantine measures for suspected cases and family members to prevent outbreaks from spreading.

Update on the treatment of musculoskeletal manifestations in chikungunya fever: a guideline.

Since the emergence of the chikungunya virus in Brazil in 2014, more than 700,000 cases have been reported throughout the country, corresponding to one-third of all cases reported in the Americas. In addition to its high attack rates, resulting in hundreds of thousands of cases, the disease has high chronicity rates with persistent joint manifestations for more than 3 months, which can spread to more than half of the patients affected in the acute phase. Pain associated with musculoskeletal manifestations, often disabling, has an effect on patients' quality of life at different stages of the disease. Currently, the challenge faced by specialists is identifying the best therapy to be instituted for symptom relief despite the limited number of published intervention studies. In 2016, a multidisciplinary group published pharmacological treatment protocols for pain in patients with chikungunya, which was incorporated into the guidelines for clinical management of the Brazilian Ministry of Health in 2017; in that same year, a consensus was published by the Brazilian Society of Rheumatology about diagnosis and treatment. After 5 years of experience with chikungunya epidemics, in 2019, specialists involved in the protocols of the Brazilian Society of Rheumatology and Brazilian Ministry of Health prepared an update with the main objective of developing flowcharts for the therapeutic approach of musculoskeletal manifestations in adult patients to enable specialists at different levels of healthcare to spread and apply this guideline in a systematic and simplified manner.

Update on the treatment of musculoskeletal manifestations in chikungunya fever: a guideline

Abstract Since the emergence of the chikungunya virus in Brazil in 2014, more than 700,000 cases have been reported throughout the country, corresponding to one-third of all cases reported in the Americas. In addition to its high attack rates, resulting in hundreds of thousands of cases, the disease has high chronicity rates with persistent joint manifestations for more than 3 months, which can spread to more than half of the patients affected in the acute phase. Pain associated with musculoskeletal manifestations, often disabling, has an effect on patients' quality of life at different stages of the disease. Currently, the challenge faced by specialists is identifying the best therapy to be instituted for symptom relief despite the limited number of published intervention studies. In 2016, a multidisciplinary group published pharmacological treatment protocols for pain in patients with chikungunya, which was incorporated into the guidelines for clinical management of the Brazilian Ministry of Health in 2017; in that same year, a consensus was published by the Brazilian Society of Rheumatology about diagnosis and treatment. After 5 years of experience with chikungunya epidemics, in 2019, specialists involved in the protocols of the Brazilian Society of Rheumatology and Brazilian Ministry of Health prepared an update with the main objective of developing flowcharts for the therapeutic approach of musculoskeletal manifestations in adult patients to enable specialists at different levels of healthcare to spread and apply this guideline in a systematic and simplified manner.