Hantavirus pulmonary syndrome: encephalitis caused by virus Andes.

Hemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome (HPS) are rodent-borne emerging diseases caused by members of the genus Hantavirus, family Bunyaviridae. Some species of hantavirus may cause encephalitis, but this is the first report in Andes virus associated to HPS.

[Abdominal bleeding due to spontaneous mesenteric vein rupture]. / Hemoperitoneo secundario a la rotura espontánea de la vena mesentérica.

UNLABELLED: Hepatic cirrhosis is the leading cause of portal hypertension and is usually associated with the development ofsplacnic varices. Variceal intraabdominal rupture is a rare cause of hemoperitoneum. A case of spontaneous mesenteric vein rupture is reported. CLINICAL CASE: 43-year-old man with hepatic cirrhosis (Child-Pugh C stage) and previous bleeding of esophageal varices, admitted to hospital because of orthostatic hypotension episodes (positive tilt test) and abdominal distention. Laboratory: anemia, low platelet count and abnormal coagulation tests. CT scan showed abdominal fluid. Exploratory laparotomy was performed and 3 liters of blood were found into the abdominal cavity. The mesenteric vein had a ruptured variceal dilatation with intermitent jet bleeding. No organ abnormalities were found. Repair of the dilated vein was performed. The patient evolved well and was dismissed from hospital ten days after admittance. OBJECTIVE: To present a case in which a rare cause of intraabdominal bleeding, usually associated with high mortality rate, is follawed by a good clinical evolution.

Utilidad de la punción lumbar en el paciente con síndrome confusional agudo y fiebre / Usefulness of the lumbar puncture in patients with acute confusional state and fever

Los estados confusionales agudos son motivo de consulta frecuente en pacientes añosos. Se evaluó la utilidad de la punción lumbar en pacientes con fiebre y síndrome confusional agudo (SCA) cuando existe un origen extrameníngeo que explique la fiebre. Criterios de inclusión: pacientes mayores de 50 años, de ambos sexos, con fiebre y SCA admitidos entre junio de 2005 y noviembre de 2006. Se excluyeron pacientes con infección por HIV o que hubieren estado internados en las últimas 72 horas. Se realizó punción lumbar (previa realización de TAC) y se analizó el líquido cefalorraquídeo (LCR). Se incluyeron 30 pacientes. 20 pacientes tuvieron una causa extrameníngea demostrada de la fiebre (66.6%). Se diagnosticaron 6 pacientes con meningitis (20%). El análisis bacteriológico directo del LCR fue positivo en 3 pacientes (10%): en 2 casos se aisló un coco gram positivo y en el restante un bacilo gram negativo. El cultivo de LCR fue positivo en dos casos (6.6%): en un caso se aisló un Streptococcus pneumoniae y en otro Escherichia coli. El hallazgo de una causa clara de fiebre no descarta la posibilidad de meningitis concomitante. Se encontró una asociación entre la presencia de hemocultivos positivos y la de meningitis, tanto en un caso de neumonía por Streptococcus neumoniae como en una infección urinaria por Escherichia coli (p=0.0022, test exacto de Fisher). Conclusión: los pacientes añosos con SCA y fiebre podrían requerir la realización de punción lumbar como parte de la evaluación inicial, independientemente de encontrarse una causa extrameníngea de la fiebre.

Acute Confusional State (ACS) is a frequent cause for seeking professional help among elderly patients. We evaluated the usefulness of lumbar puncture in patients with acute confusional state and fever, when an evident extrameningeal cause of fever is present. All patients over 50 years of age, from both sexes, with fever and ACS, who were admitted to hospital in a period between June 2005 and November 2006, were included. Patients with a history of HIV infection and patients who had been hospitalized within the previous 72 hours were excluded. Lumbar puncture was performed, and the cerebrospinal fluid (CSF) was analyzed. Thirty patients were included. Twenty of the included patients (66.6%) had a demonstrable extrameningeal fever cause. Six patients (20%) with meningitis were detected. The CSF bacteriologic smear was positive in 3 patients (10%); in two cases a gram positive coccus was identified and in one case a gram negative bacillus. The CSF culture was positive in two patients (6.6%) for Escherichia coli (o and Streptococcus pneumoniae. The finding of a clear cause for fever does not rule out the possibility of meningitis. We found an association between the positive blood cultures and the presence of meningitis, both in a case of pneumococcal pneumonia and in a case of urinary tract infection due to Escherichia coli (p=0.0022, Fisher’s Exact test). We conclude that all elderly patients with ACS and fever may require performing a lumbar puncture as part of the initial assessment, regardless of the finding of a extrameníngeal cause of fever.

Hemoperitoneo secundario a la rotura espontánea de la vena mesentérica / Abdominal bleeding due to spontaneous mesenteric vein rupture

La cirrosis hepática es la principal causa de hipertensión portal y se asocia con el desarrollo de venas esplácnicas varicosas. La rotura de várices intraabdominales es una causa rara de hemoperitoneo. Se presenta el caso de hemoperitoneo espontáneo por rotura de vena mesentérica superior varicosa. Caso clínico: varón de 43 años con antecedentes de cirrosis alcohólica (estadio C de Child-Pugh) y múltiples internaciones por hemorragia digestiva variceal. Consulta por episodios sincopales y distensión abdominal. Al examen físico se presento: vigil, orientado, hipotenso, con tilt test positivo, distensión abdominal, estigmas cutáneos de hepatopatía crónica. Laboratorio: anemia, plaquetopenia, rolongación de los tiempos de coagulación. TAC de abdomen: líquido libre en cavidad peritoneal. Laparotomía exploradora: se extraen tres litros de sangre de cavidad abdominal. Se visualiza vena mesentérica superior varicosa con una zona en forma de pezón que muestra punto de sangrado en jet, intermitente. No se evidenció daño de otro órgano. Se procedió a la rafia de la lesión lográndose hemostasia. El paciente evolucionó favorablemente abandonando el hospital 10 días después del ingreso. Objetivo: presentar un paciente con una causa poco común de hemoperitoneo y remarcar la buena evolución, ya que este tipo de patología suele tener alta mortalidad.

Hepatic cirrhosis is the leading cause of portal hypertension and is usually associated with the development of splacnic varices. Variceal intraabdominal rupture is a rare cause of hemoperitoneum. A case of spontaneous mesenteric vein rupture is reported. Clinical case: 43 year old man with hepatic cirrhosis (Child-Pugh C stage) and previous bleeding of esophageal varices, admitted to hospital because of orthostatic hypotension episodes (positive tilt test) and abdominal distention. Laboratory: anemia, low platelet count and abnormal coagulation tests. CT scan showed abdominal fluid. Exploratory laparotomy was performed and 3 liters of blood were found into the abdominal cavity. The mesenteric vein had a ruptured variceal dilatation with intermitent jet bleeding. No organ abnormalities were found. Repair of the dilated vein was performed. The patient evolved well and was dismissed from hospital ten days after admittance. Objective: To present a case in which a rare cause of intraabdominal bleeding, usually associated with high mortality rate, is follawed by a good clinical evolution.