RESUMO
In the spring of 1996, multiple cases of an acute febrile illness resulting in several deaths in remote locations in Peru were reported to the Centers for Disease Control and Prevention (CDC). The clinical syndromes for these cases included dysphagia and encephalitis. Because bat bites were a common occurrence in the affected areas, the initial clinical diagnosis was rabies. However, rabies was discounted primarily because of reported patient recovery. Samples of brain tissue from two of the fatal cases were received at CDC for laboratory confirmation of the rabies diagnosis. An extensive array of tests on the formalin-fixed tissues confirmed the presence of both rabies viral antigen and nucleic acid. The virus was shown to be most closely related to a vampire bat rabies isolate. These results indicate the importance of maintaining rabies in the differential diagnosis of acute febrile encephalitis, particularly in areas where exposure to vampire bats may occur.
Assuntos
Encefalopatias/diagnóstico , Encéfalo/virologia , Quirópteros/virologia , Vírus da Raiva/isolamento & purificação , Raiva/diagnóstico , Animais , Anticorpos Monoclonais , Anticorpos Antivirais/sangue , Antígenos Virais/análise , Sequência de Bases , Encéfalo/ultraestrutura , Encefalopatias/virologia , Primers do DNA/química , Surtos de Doenças , Vetores de Doenças , Feminino , Técnica Direta de Fluorescência para Anticorpo , Histocitoquímica , Humanos , Hibridização In Situ , Camundongos , Camundongos Endogâmicos ICR , Dados de Sequência Molecular , Hibridização de Ácido Nucleico , Peru , Reação em Cadeia da Polimerase , Raiva/mortalidade , Raiva/virologia , Vírus da Raiva/genética , Vírus da Raiva/imunologia , Alinhamento de Sequência , Homologia de Sequência do Ácido NucleicoRESUMO
Fifty-two patients treated for painful wrists during a seven-year period at a referral clinic were studied. Forty-seven were women, and of these, twenty-seven were nursing mothers. This presentation shows the results of an investigation into some of the factors in the aetiology of this condition. Handling of the baby, especially those of higher birth weight, may be a contributing factor in the production of the disease. Conservative treatment by injection of local anaesthetic and hydrocortisone mixture into the tendon sheath is successful in early cases. Late cases benefit from operative relief of the stenosis (AU)