Unusual clinical manifestations of dengue disease - Real or imagined?

The disease caused by each of the four serotypes of dengue virus (DENV) have plagued humans since last century. Symptoms of dengue virus (DENV) infection range from asymptomatic to dengue fever (DF) to severe dengue disease (SDD). One third of the world's population lives in regions with active urban DENV transmission, and thousands of serologically naïve travelers visit these areas annually, making a significant portion of the human population at risk of being infected. Even though lifelong immunity to the homotypic serotype is achieved after a primary DENV infection. Heterotypic DENV infections may be exacerbated by a pre-existing immune memory to the primary infection and can result in an increased probability of severe disease. Not only, age, comorbidities and presence of antibodies transferred passively from dengue-immune mother to infants are considered risk factors to dengue severe forms. Plasma leakage and multiple organ impairment are well documented in the literature, affecting liver, lung, brain, muscle, and kidney. However, unusual manifestation, severe or not, have been reported and may require medical attention. This review will summarize and discuss the increasing reports of unusual manifestations in the clinical course of dengue infection.

¿Debemos promover la vacuna contra la influenza? / Should we promote the use of the anti-flu vaccine?

En México se carece de una cultura adecuada de lo que es la gripe o influenza y de la utilización de su vacuna, por lo que se hace una semblanza de la enfermedad y de las indicaciones de la vacuna inactivada y elaborada con subvirión, a fin de promover su empleo en el país para prevenir ese padecimiento y sus complicaciones.

[Reye syndrome: a case study in a Cuban provincial hospital from 1990 to 1996]. / Síndrome de Reye: estudio de la casuística de un hospital provincial cubano entre 1990 y 1996.

INTRODUCTION: Reye's syndrome is a metabolic encephalopathy of infancy which is often fatal. Epidemiological studies have shown associated factors including having taken Aspirin for viral illness. Some patients with this disorder may have preexisting organic acidemia such as dicarboxylic aciduria. OBJECTIVE: To study the behavior of Reye's syndrome in a group of patients during the years 1990-1996 in a provincial paediatric hospital and review variables such as age, sex, race, prodromal illness, previous consumption of Aspirin, hospital stay, mortality, diagnosis of dicarboxylic aciduria, etc. PATIENTS AND METHODS: We selected patients with Reye's syndrome seen during the period mentioned and considered the above variables. RESULTS: All 10 patients seen with Reye's syndrome were boys. Their ages were between 3 months and 2 years. Most (nine) of the patients were Caucasian. All patients had influenza as the prodromal illness, and all took Aspirin as an antipyretic. There was considerable variation in the length of their stay in the hospital. In our series there was a high mortality and only two patients survived. One boy had dicarboxylic aciduria. CONCLUSIONS: The fatal character of Reye's syndrome has been shown, as has its relation to the use Aspirin. In our environment there seems to be a tendency for Caucasian boys to be affected.

[Reye's syndrome in an adult. Review of pathogenic mechanisms]. / Síndrome de Reye en un adulto. Revisión de los mecanismos patogénicos.

Reye's syndrome is considered a disease of the pediatric age. It is characterized by a prodrome of viral illness followed by vomiting and encephalopathy with associated hepatic dysfunction. This syndrome is potentially life-threatening with high morbidity and mortality rates. There are 27 other cases of adult onset Reye's syndrome reported in the literature. We describe a 18-year-old woman who developed varicella and four days later started with vomiting, delirium and in the following day she became comatose. Laboratory tests of liver function and pathology of a liver biopsy proved the diagnosis. The patient survived. A review of the proposed pathogenic mechanisms are presented. Our patient represents case the number 28 in world literature and the first in the mexican literature.

Síndrome de Reye : Informe de un caso en adultos

Se describe el caso de una mujer joven atendida en el hospital San Ignacio (Santa Fe de Bogotá), con diagnostico post mortem de síndrome de Reye. Seguidamente, se revisan y discuten los aspectos fisiopatológicos y los concernientes al diagnóstico y la terapéutica.

Renal handling of carnitine in children with carnitine deficiency and hyperammonemia associated with valproate therapy.

Free and acylcarnitine in serum and urine samples were measured in five patients with hyperammonemia associated with anticonvulsant therapy including sodium valproate, of whom three had a Reye-like syndrome. All had considerable reduction in serum free carnitine and slight increase of acylcarnitine concentrations, suggesting increased conversion of free to acylcarnitine by valproate administration. Urinary excretion of both free and acylcarnitine was increased, accompanied by depressed reabsorption of free carnitine and decreased acylcarnitine/free carnitine clearance ratio. These results indicate a decreased threshold for free carnitine. The combination of these several factors may be responsible for carnitine deficiency in patients with hyperammonemia taking valproate.

Recognition of medium-chain acyl-CoA dehydrogenase deficiency in asymptomatic siblings of children dying of sudden infant death or Reye-like syndromes.

The medium-chain acyl-CoA dehydrogenase (MCAD) deficiency of mitochondrial beta oxidation has been identified in two asymptomatic siblings in a family in which two previous deaths had been recorded, one attributed to sudden infant death syndrome and the other to Reye syndrome. Recognition of this disorder in one of the deceased and in the surviving siblings was accomplished by detection of a diagnostic metabolite, octanoylcarnitine, using a new mass spectrometric technique. This resulted in early treatment with L-carnitine supplement in the survivors, which should prevent metabolic deterioration. Further studies suggest that breast-feeding may be protective for infants with MCAD deficiency. Families with children who have had Reye syndrome or in which sudden infant death has occurred are at risk for MCAD deficiency. We suggest that survivors and asymptomatic siblings should be tested for this treatable disorder.

Presence of aflatoxin B1 in human liver referred to as Reye's syndrome in Venezuela

Una muestra de hígado humano fue obtenida de la autopsia practicada a un paciente admitido en el Hospital Universitario de Los Andes, Mérida, Venezuela. El paciente quien parecía sufrir una enfermedad la cual fue referida al Síndrome de Reye, presentó entre otros hallazgos: degeneración grasa y en largamiento del hígado, encefalopatía y hemorragia de la tráquea, de la mucosa del ileum y del ciego. Este reporte presenta evidencia de la presencia de Aflatoxina B1 en el tejido hepático. Ningún otro metabolito fue detectado. Un número de reportes han sido asociados con el Síndrome de Reye y la presencia de Aflatoxina B1 en tejido, pero hasta ahora, ésta es la primera evidencia reportada en nuestro país

Síndrome de Reye: revisión y análisis de un caso / Reye's syndrome: review and analysis of a case

Se presentan los principales síntomas, signos y datos de laboratorio que permiten diagnosticar el síndrome de Reye. Esta entidad, reconocida aproximadamente hace 25 años, se tipifica fundamentalmente por la coexistencia de encefalopatía no inflamatoria y degeneración grasa del hígado. En este trabajo destaca la alta frecuencia de procesos virales en relación con prescripciones de algunos medicamentos, entre los que sobresalen los salicilatos. Cabe agregar que el pediatra habrá de manejar con cautela los preparados antipiréticos y analgésicos. Además, el trabajo se ilustra con la presentación del caso de una niña mexicana

An epidemic of Reye syndrome associated with influenza A (H1N1) in Colorado.

An unusual cluster of Reye syndrome was associated with an outbreak of influenza A (H1N1) infections in the state of Colorado. Two of the 16 affected children had had prior episodes of Reye syndrome following respiratory infections, and one had had transverse myelitis following varicella. A serologic study of patients treated at a children's hospital and serum specimens submitted to the state health department revealed that approximately 59% of children in Colorado had been infected with the H1N1 strain of influenza A over a two-year period. Based upon this serologic survey, the minimum and maximum rates of Reye syndrome associated with H1N1 infections were calculated to be 2.5 and 4.3 cases per 100,000 H1N1 infections, respectively. A retrospective analysis of admissions to four referral hospitals in Denver failed to reveal any unusual clustering of Reye syndrome with outbreaks of influenza A H3N2 infections during 1975-1978. The reason for an association between Reye syndrome and the H1N1 strain but not the H3N2 strains of influenza A remains unclear.

Adult Reye's syndrome after dengue

An adult (21 year old) male is described who developed Reye's syndrome in association with dengue type 1 infection (AU)

Reye syndrome in siblings.

Reye syndrome in siblings was seen in three of 85 families; the incidence of RS in these family groups appears to exceed that of the general population. The interval between development of RS in the first and second siblings was two to 11 days and related to the incubation period of the initial viral infection. In five of the children this infection was chickenpox and in two, an unspecified upper respiratory illness. To assess the role of genetic factors, HLA typing was performed on these siblings; a common genetic marker indicating susceptibility to RS was not identified. All families resided in rural and suburban areas; exposure to a common environmental toxin was not identified.