Tenosinovitis por virus Chikungunya / Tenosynovitis due to Chikungunya virus

Se presenta a la consulta un hombre proveniente de la República Dominicana con una tenosinovitis del extensor del dedo medio derecho; en la convalecencia inmediata, segunda curva febril luego de 48 horas de permanecer asintomático de una enfermedad febril aguda, y marcada astenia, exantema pruriginoso, poliartralgias con impotencia funcional y rigidez articular generalizada. Los exámenes bioquímicos no aportaron datos de interés para el diagnóstico. La serología para virus dengue fue negativa. La detección de IgM y de anticuerpos neutralizantes para virus Chikungunya (CHIKV) fueron positivos.

We report the case of a man from Dominican Republic who consulted for a tenosynovitis of the right middle finger extensor; in the immediate convalescence second febrile curve, after 48 hours of no symptoms of an acute febrile illness, with marked fatigue, itchy rash, polyarthralgia, functional impairment and general stiffness. Biochemical tests did not provide useful data for diagnosis. Dengue virus serology was negative. Detection of IgM and neutralizing antibodies (PRNT) for Chikundunya virus (CHIKV) were positive.

[Tenosynovitis due to Chikungunya virus]. / Tenosinovitis por virus Chikungunya.

We report the case of a man from Dominican Republic who consulted for a tenosynovitis of the right middle finger extensor; in the immediate convalescence second febrile curve, after 48 hours of no symptoms of an acute febrile illness, with marked fatigue, itchy rash, polyarthralgia, functional impairment and general stiffness. Biochemical tests did not provide useful data for diagnosis. Dengue virus serology was negative. Detection of IgM and neutralizing antibodies (PRNT) for Chikundunya virus (CHIKV) were positive.

Tenosinovitis por virus Chikungunya. / [Tenosynovitis due to Chikungunya virus].

We report the case of a man from Dominican Republic who consulted for a tenosynovitis of the right middle finger extensor; in the immediate convalescence second febrile curve, after 48 hours of no symptoms of an acute febrile illness, with marked fatigue, itchy rash, polyarthralgia, functional impairment and general stiffness. Biochemical tests did not provide useful data for diagnosis. Dengue virus serology was negative. Detection of IgM and neutralizing antibodies (PRNT) for Chikundunya virus (CHIKV) were positive.

[Outbreak of St. Louis encephalitis in the Metropolitan Buenos Aires Area]. / Brote de encefalitis de San Luis en el área metropolitana Buenos Aires.

We describe the epidemiological and clinical findings of 13 patients with diagnosis of infection by St. Louis encephalitis virus, transmitted between January and March 2010 in Buenos Aires Metropolitan Area (AMBA). Thirteen patients, average age 38 years, had an acute onset with hyperthermia and headache. Between days two and ten of the onset of symptoms, 7/13 patients had signs and symptoms of neurological involvement. This was characterized by meningitis without encephalic sings in 1/7 and in 6/7 the most frequent findings were: stiff neck, disorientation, photophobia, confusion and language impairment. Two MR and one EEG revealed signs of involvement of temporal lobes. The cerebrospinal fluid showed pleocytosis with predominance of mononuclear cells, normal glucose and moderately elevated protein. There were no fatalities cases. In 6/13 patients the initial clinical suspicion was dengue. As epidemic virus circulation had not been previously reported in the AMBA it can be considered an outbreak of St. Louis encephalitis for the spatial and temporal clustering of cases.

Brote de encefalitis de San Luis en el Área Metropolitana Buenos Aires / Outbreack of St. Luis encephalitis in the Metropolitan Buenos Aires Area

Se describen los hallazgos epidemiológicos y clínicos de 13 enfermos con diagnóstico de infección por virus de la encefalitis de San Luis, con transmisión entre enero y marzo de 2010, en el Area Metropolitana Buenos Aires (AMBA). Los 13 enfermos, promedio de edad 38 años, tuvieron un comienzo agudo caracterizado por hipertermia y cefalea. Entre los días dos y diez de iniciados los síntomas, 7/13 enfermos tuvieron signos y síntomas de compromiso neurológico caracterizado por meningitis sin signos encefálicos en 1/7. En 6/7 los hallazgos más frecuentes fueron: rigidez de nuca, desorientación temporoespacial, fotofobia, confusión y alteración del lenguaje. Dos resonancias magnéticas y un electroencefalograma presentaron signos de afectación de lóbulos temporales. El líquido cefalorraquídeo se caracterizó por pleocitosis con predominio de células mononucleadas, glucorraquia normal y discreto aumento de proteínas. No hubo casos fatales. En 6/13 pacientes la sospecha clínica inicial fue dengue. Por la agrupación espacial y temporal de los casos puede considerarse un brote epidémico, el primero conocido en el AMBA, ya que no se había notificado previamente la circulación epidémica del virus.

We describe the epidemiological and clinical findings of 13 patients with diagnosis of infection by St. Louis encephalitis virus, transmitted between January and March 2010 in Buenos Aires Metropolitan Area (AMBA). Thirteen patients, average age 38 years, had an acute onset with hyperthermia and headache. Between days two and ten of the onset of symptoms, 7/13 patients had signs and symptoms of neurological involvement. This was characterized by meningitis without encephalic sings in 1/7 and in 6/7 the most frequent findings were: stiff neck, disorientation, photophobia, confusion and language impairment. Two MR and one EEG revealed signs of involvement of temporal lobes. The cerebrospinal fluid showed pleocytosis with predominance of mononuclear cells, normal glucose and moderately elevated protein. There were no fatalities cases. In 6/13 patients the initial clinical suspicion was dengue. As epidemic virus circulation had not been previously reported in the AMBA it can be considered an outbreak of St. Luis encephalitis for the spatial and temporal clustering of cases.

Líquido cefalorraquídeo en pacientes con criptococosis asociada al SIDA / CSF in patients with AIDS associated cryptococcosis

Se analizaron retrospectivamente los líquidos céfalorraquídeos (LCR) de 44 pacientes con criptococosis asociada al SIDA, internados en la Sala XI del Hospital Muñiz, entre enero de 2000 y diciembre de 2004. Se tuvieron en cuenta en cada caso las características físico-químicas, citológicas y micológicas de los LCR obtenidos por punción lumbar al momento de la admisión. La microscopia con tinta china fue positiva en 38 (90.5%) de 42 pacientes con ese dato disponible. Los 6 pacientes restantes se diagnosticaron por cultivos y/o determinación de antígeno de Cryptococcus neoformans. En el examen físico, 29 (69%) de 42 muestras disponibles, presentaron aspecto límpido y las 13 restantes fueron hemorrágicas (n=3), opalescentes (n=6), xantocrómicas (n=3) o turbias (n=1). Del análisis químico, se obtuvo para la proteinorraquia una mediana de 0,7 g/L (rango 0,1-3,5), de 38 mg/dL (rango 12-75) para la glucorraquia y de 127 meq/L (rango 130-143) para la clorurorraquia. La determinación del antígeno capsular, disponible para 7 muestras de LCR y sangre, mostró una mediana de 1/1.000, con valores más elevados en sangre. Las características del LCR de los pacientes examinados con criptococosis asociada al SIDA no revelaron, al menos en los parámetros evaluados, alteraciones diferentes a las mencionadas en la literatura.

Cerebrospinal fluids (CSF) of 44 patients with cryptococcosis associated with Acquired Immunodeficiency Syndrome (AIDS), treated in the Ward XI of the Muñiz Hospital from January 2000 to December 2004, were retrospectively analyzed. The physical, chemical, cytological and mycological characteristics of CSF obtained by lumbar puncture at the moment of admission were taken into account in each case. India ink microscopy was positive in 38 (90.5%) out of 42 patients and the remainning 6 patients were diagnos- ed by cultures and/or determination of capsular antigen of Cryptococcus neoformans. At physical examination, 29 (69%) out of 42 samples showed a limpid aspect and the remaining 13 were hemorrhagic (n=3), opalescent (n=6), xanthochromic (n=3) or turbid (n=1). Chemically, the median of proteinorraquia was 0.7 g/L (range 0.1-3.5 g/L), 38 g/L (range 12-75 g/L) for glycorrhachia and 127 meq/L (range 130-143 mEq/L) for clorurorrachia. The capsular antigen of Cryptococcus neoformans, available for 7 CSF and blood samples, showed a median of 1/1.000 in both, with higher values in blood than in CSF. The CSF of patients with AIDS associated cryptococcosis evaluated in the present study did not reveal important differences, at least in the evaluated parameters, with respect to those cited in the literature.