Dengue fever and human T-cell lymphotropic virus type 1 infection.

Globalization has increased both the number of emergent diseases and the diversity of co-infections, which could in turn mutually influence the pathogenesis of well-known infectious diseases. Here, we report the first series of chronic human T-cell lymphotropic virus type 1 (HTLV-1) patients co-infected with the dengue fever virus. As both of these diseases are immuno-mediated, we anticipated interference in the development of both diseases, with atypical clinical and laboratory parameter results. All the patients had classic dengue fever, and the main outstanding abnormality was leukopenia associated with lymphopenia. Although a mutual influence was expected, dengue fever did not affect the clinical course of HTLV-1 infection, and HTLV-1 proviral loads revealed unpredictable patterns of change.

Splenectomy in cirrhosis with hypersplenism: improvement in cytopenias, Child's status and institution of specific treatment for hepatitis C with success.

INTRODUCTION: Hypersplenism in cirrhosis is not infrequent and may compromise with quality of life and therapy. Splenectomy is a therapeutic option, but information on results of splenectomy is scarce. MATERIAL AND METHODS: Consecutive patients with cirrhosis who underwent splenectomy between 2001-2010 were included in the study. Safety, efficacy of splenectomy and subsequent influence on therapy were evaluated. RESULTS: Thirty three patients (mean age 30.9 ± 11.6 years, 19 men, viral 48.5%, autoimmune 15.1%, cryptogenic 36.4%) underwent splenectomy. Twenty were Child's A, 13 Child's B. Twenty patients had > 6 months follow up. Common indications were inability to treat with interferon, transfusion-dependent anemia, recurrent mucosal bleeds, and large spleen compromising quality of life. Median hospital stay was 7 (4-24) days. There was no splenectomy related mortality. Twenty three (70%) patients had post-operative complications, most commonly infections. Two patients required percutaneous drainage of post-operative collections, and 1 needed re-exploration for intra-abdominal bleed. Subsequent to splenectomy platelet count (44,000 to 151,000/mm 3 , p < 0.01) and TLC (2,500 to 13,400/mm 3 , p < 0.01) had sustained increase in all patients except one. Five HCV cirrhotics completed interferon and ribavirin therapy, 4 achieved sustained viral response. The quality of life improved and there was no recurrence of infections, mucosal bleed or anemia requiring transfusions in any patient. In patients on long term follow up (median duration 27 months), the median Child's score improved from 6 at baseline to 5 at follow up (p < 0.05). CONCLUSIONS: Splenectomy was safe and effective in patients with cirrhosis, and improved therapeutic options as well as Child's score.

Utility of the tourniquet test and the white blood cell count to differentiate dengue among acute febrile illnesses in the emergency room.

Dengue often presents with non-specific clinical signs, and given the current paucity of accurate, rapid diagnostic laboratory tests, identifying easily obtainable bedside markers of dengue remains a priority. Previous studies in febrile Asian children have suggested that the combination of a positive tourniquet test (TT) and leucopenia can distinguish dengue from other febrile illnesses, but little data exists on the usefulness of these tests in adults or in the Americas. We evaluated the diagnostic accuracy of the TT and leucopenia (white blood cell count <5000/mm(3)) in identifying dengue as part of an acute febrile illness (AFI) surveillance study conducted in the Emergency Department of Saint Luke's Hospital in Ponce, Puerto Rico. From September to December 2009, 284 patients presenting to the ED with fever for 2-7 days and no identified source were enrolled. Participants were tested for influenza, dengue, leptospirosis and enteroviruses. Thirty-three (12%) patients were confirmed as having dengue; 2 had dengue co-infection with influenza and leptospirosis, respectively. An infectious etiology was determined for 141 others (136 influenza, 3 enterovirus, 2 urinary tract infections), and 110 patients had no infectious etiology identified. Fifty-two percent of laboratory-positive dengue cases had a positive TT versus 18% of patients without dengue (P<0.001), 87% of dengue cases compared to 28% of non-dengue cases had leucopenia (P<0.001). The presence of either a positive TT or leucopenia correctly identified 94% of dengue patients. The specificity and positive predictive values of these tests was significantly higher in the subset of patients without pandemic influenza A H1N1, suggesting improved discriminatory performance of these tests in the absence of concurrent dengue and influenza outbreaks. However, even during simultaneous AFI outbreaks, the absence of leucopenia combined with a negative tourniquet test may be useful to rule out dengue.

Alterações hematológicas em pacientes com dengue / Hematological abnormalities in patients with dengue

Dengue é uma doença negligenciada de alta morbidade e mortalidade em crianças e adultos, ocorrendo principalmente em regiões tropicais e subtropicais. O objetivo desse trabalho foi avaliar as alterações hematológicas de pacientes com quadro clínico de dengue. Foram estudados 543 prontuários de atendimentos referentes à epidemia pelo vírus tipo 3, ocorrida no ano de 2007, em Campo Grande, Mato Grosso do Sul. Houve predomínio de casos de dengue clássico (90,2 por cento), com quadro clínico leve sem complicações. As principais alterações hematológicas observadas foram a leucopenia (68,3 por cento), plaquetopenia (66,5 por cento), linfocitopenia (67,2 por cento) e presença de linfócitos atípicos (67 por cento). A febre hemorrágica do dengue apresentou plaquetopenia mais prolongada e maior número de linfócitos atípicos, as demais alterações hematológicas apresentaram evolução diária semelhante às encontradas no dengue clássico. As alterações hematológicas observadas no dengue apresentaram-se de acordo com a evolução clínica e gravidade da doença.

Dengue is a neglected disease with high morbidity and mortality among children and adults that occurs mainly in tropical and subtropical regions. The objective of this study was to evaluate hematological changes in patients with clinical manifestations of dengue. Medical records relating to 543 cases of dengue virus 3 that occurred during the 2007 epidemic in Campo Grande, Mato Grosso do Sul, were studied. Cases of classic dengue predominated (90.2 percent), with mild clinical manifestations lacking complications. The main hematological findings were leukopenia (68.3 percent), thrombocytopenia (66.5 percent), lymphocytopenia (67.2 percent) and atypical lymphocytes (67 percent). In dengue hemorrhagic fever, thrombocytopenia was more prolonged and the number of atypical lymphocytes was higher, while the other hematological abnormalities presented daily evolution similar to those in classic dengue. The hematological changes observed in dengue present according to the clinical course of the disease and its severity.

[Hematological abnormalities in patients with dengue]. / Alterações hematológicas em pacientes com dengue.

Dengue is a neglected disease with high morbidity and mortality among children and adults that occurs mainly in tropical and subtropical regions. The objective of this study was to evaluate hematological changes in patients with clinical manifestations of dengue. Medical records relating to 543 cases of dengue virus 3 that occurred during the 2007 epidemic in Campo Grande, Mato Grosso do Sul, were studied. Cases of classic dengue predominated (90.2%), with mild clinical manifestations lacking complications. The main hematological findings were leukopenia (68.3%), thrombocytopenia (66.5%), lymphocytopenia (67.2%) and atypical lymphocytes (67%). In dengue hemorrhagic fever, thrombocytopenia was more prolonged and the number of atypical lymphocytes was higher, while the other hematological abnormalities presented daily evolution similar to those in classic dengue. The hematological changes observed in dengue present according to the clinical course of the disease and its severity.

Effect of white cell counts on the presence of human herpes simplex virus type-1 in saliva of pediatric oncology patients.

OBJECTIVE: The objective of this study was to assess if there is increased herpes simplex virus type 1 (HSV-1) salivary shedding in oncology pediatric patients with severe cytopenia (SC). STUDY DESIGN: HSV-1 was detected by real time PCR in saliva samples from oncology pediatric patients (n = 30) during SC and relative cytopenia (RC), and from healthy children (n = 27). RESULTS: The frequency of HSV-1 positive saliva samples was higher in patients with SC as compared to controls (P < .05), and this frequency presented a significant reduction during RC periods (P < .02). The SC group positive for HSV-1 presented both a twofold increase in the neutrophil-to-lymphocyte ratio as compared with SC patients negative for HSV-1 (P < .05), and a positive correlation between neutrophil and lymphocyte counts (P < .05, R = 0.82, R(2) = 0.67). This correlation was not found in oncology patients negative for HSV-1 during SC and RC. CONCLUSION: Severe cytopenia in oncology pediatric patients could be an important susceptibility factor for increased HSV-1 salivary shedding.