RÉSUMÉ
BACKGROUND: Pertussis is a highly contagious disease of public health interest caused by the bacterium Bordetella pertussis. Although its incidence has decreased substantially after the introduction of a vaccination, the burden of the disease remains high. Although the paroxysmal phase is highly disabling, complications are uncommon and more prevalent in children than in adults. The most frequent neurological complication is encephalopathy, but seizures, paresis, paraplegia, ataxias, aphasias, and decerebration postures have also been described. The complication of decerebration postures has not been previously reported in adults. CASE PRESENTATION: We present a video case of an adult HIV patient with severe coughing paroxysms, post-tussive emesis and syncope, whose workup confirmed the diagnosis of a B. pertussis respiratory infection. During hospitalization, he had fluctuant encephalopathy and post-tussive decerebration postures following paroxysms. He was treated with antibiotic therapy and finally sent home without residual neurological deficits. CONCLUSION: This case illustrates the biological plausibility of neurologic complications of pertussis in adults, which, albeit rare, can cause important morbidities. Future research should explore whether there are differences in the clinical presentation, risk factors and pathophysiology of the disease among adults or interventions aimed at preventing or treating pertussis encephalopathy.
Sujet(s)
Infections opportunistes liées au SIDA/complications , Bordetella pertussis/génétique , Encéphalopathies/complications , Décérébration/complications , VIH (Virus de l'Immunodéficience Humaine) , Coqueluche/complications , Infections opportunistes liées au SIDA/traitement médicamenteux , Infections opportunistes liées au SIDA/virologie , Antibactériens/usage thérapeutique , Bordetella pertussis/isolement et purification , Encéphalopathies/traitement médicamenteux , Encéphalopathies/microbiologie , Décérébration/traitement médicamenteux , Décérébration/microbiologie , Hospitalisation , Humains , Mâle , Adulte d'âge moyen , Réaction de polymérisation en chaîne , Facteurs de risque , Résultat thérapeutique , Coqueluche/traitement médicamenteux , Coqueluche/microbiologieRÉSUMÉ
Os autores estudaram a incidência de cervicalgia e de alterações posturais em pacientes portadores de DTM. Foram avaliados 307 pacientes (64 homens e 243 mulheres) no período de 1996 a 2002. Dos pacientes avaliados, 86,97% apresentaram dor na região cervical, 260 (84,69%) apresentaram anteriorização do segmento cefálico e 254 (82,74%) apresentaram protrusão dos ombros