Adult Reye-like syndrome associated with serologic evidence of acute parvovirus B19 infection

Reye's syndrome is an infrequently diagnosed medical condition affecting mainly children. The etiology, epidemiology and natural history of Reye's syndrome have been cloudily written in footnotes of medical books and exotic papers since the initial description in early 1950s. We report here a case of adult Reye's syndrome associated with serologic evidence of parvovirus B19 infection.

Adult Reye-like syndrome associated with serologic evidence of acute parvovirus B19 infection.

Reye's syndrome is an infrequently diagnosed medical condition affecting mainly children. The etiology, epidemiology and natural history of Reye's syndrome have been cloudily written in footnotes of medical books and exotic papers since the initial description in early 1950s. We report here a case of adult Reye's syndrome associated with serologic evidence of parvovirus B19 infection.

Tatumella ptyseos causing severe human infection: report of the first two Brazilian cases

Tatumella ptyseos is the type species of the Tatumella genus (Enterobacteriaceae). This fermentative Gram-negative rod has only rarely been reported as a cause of human infections; there is very little information about it in the medical literature. We report here the first two Brazilian cases of T. ptyseos infections, both evolving to severe sepsis.

Tatumella ptyseos causing severe human infection: report of the first two Brazilian cases.

Tatumella ptyseos is the type species of the Tatumella genus (Enterobacteriaceae). This fermentative Gram-negative rod has only rarely been reported as a cause of human infections; there is very little information about it in the medical literature. We report here the first two Brazilian cases of T. ptyseos infections, both evolving to severe sepsis.

Questing one Brazilian query: reporting 16 cases of Q fever from Minas Gerais, Brazil.

Q fever has been considered non-existing in Brazil where reports of clinical cases still cannot be found. This case-series of 16 patients is a result of a systematic search for such illness by means of clinical and serologic criteria. Serologic testing was performed by the indirect microimmunofluorescence technique using phase I/II C. burnetii antigens. Influenza-like syndrome was the most frequent clinical form (eight cases--50%), followed by pneumonia, FUO (fever of unknown origin), mono-like syndrome (two cases--12.5% each), lymphadenitis (one case--6.3%) and spondylodiscitis associated with osteomyelitis (one case--6.3%). The ages varied from four to 67 years old with a median of 43.5. All but one patient had positive serologic tests for phase II IgG whether or not associated with IgM positivity compatible with acute infection. One patient had both phase I and phase II IgG antibodies compatible with chronic Q fever. Seroconvertion was detected in 10 patients. Despite the known limitations of serologic diagnosis, the cases here reported should encourage Brazilian doctors to include Q fever as an indigenous cause of febrile illness.

Questing one Brazilian query: reporting 16 cases of Q fever from Minas Gerais, Brazil

A febre Q continua sendo considerada inexistente no Brasil onde publicações de casos clínicos ainda não são encontráveis. Esta série de casos de 16 pacientes é resultado de uma busca sistemática para esta doença usando-se critérios clínicos e sorológicos. Os testes sorológicos foram realizados pela técnica de microimunofluorescência indireta utilizando-se antígenos de C. burnetii fase I e fase II. Síndrome influenza símile foi a forma clínica mais frequente (oito casos - 50%), seguida pela pneumonia, FOI (febre de origem indeterminada), síndrome mononucleose símile (dois casos - 12,5% cada) e por fim linfoadenite (um caso - 6,3%) e espondilodiscite associada à osteomielite (um caso - 6,3%). As idades variaram de quatro a 67 anos com mediana de 43,5. Todos os pacientes, com exceção de um, tinham testes sorológicos positivos para IgG anti fase II, associado ou não a IgM anti fase II, compatíveis com infecção aguda. Um paciente tinha tanto anticorpos IgG anti fase I quanto anti fase II compatíveis com febre Q crônica. Soroconversão foi detectada em 10 pacientes. A despeito das conhecidas limitações do diagnóstico sorológico os casos aqui relatados devem encorajar os médicos brasileiros a incluir a febre Q como causa nativa de doença febril neste país a ser pesquisada.

More about human monocytotropic ehrlichiosis in Brazil: serological evidence of nine new cases

Human Ehrlichia chaffeensis infections have been reported in North America, Asia and Europe, but only recently have human cases been reported in Brazil. Nine new human cases of E. chaffeensis infection diagnosed on a clinical and serological basis are reported. Serological tests were performed with indoor slides prepared with CDC stock DH-82 cells infected with E. chaffeensis (Arkansas strain). All but two patients were adults. Seven patients were male and two female. The fever duration varied from 4 to 120 days with a median of 6 days. All patients recalled previous tick attack. IgM was detected in four cases. Influenza like syndrome was the most frequent clinical form affecting five patients. Two patients had fever of unknown origin (FUO), one patient had blood culture-negative endocarditis and one had encephalitis. All patients except one recovered. Two patients were correctly treated. One patient with FUO had AIDS and unexplained pancytopenia. The occurrence of human ehrlichiosis by E. chaffeensis remains to be proved in Brazil; the cases reported here highlight the possibility of such disease occurrence in Brazil.

Antibodies to Rickettsia rickettsii, Rickettsia typhi, Coxiella burnetii, Bartonella henselae, Bartonella quintana, and Ehrlichia chaffeensis among healthy population in Minas Gerais, Brazil

Rickettsial diseases except those belonging to spotted fever group rickettsioses are poorly studied in South America particularly in Brazil where few epidemiological reports have been published. We describe a serosurvey for Rickettsia rickettsii, R. typhi, Coxiella burnetii, Bartonella henselae, B. quintana, and Ehrlichia chaffeensis in 437 healthy people from a Brazilian rural community. The serum samples were tested by indirected micro-immunoflourescence technique and a cutoff titer of 1:64 was used. The seroprevalence rates for R. rickettsii, R. typhi, C. burnetii, B. henselae, B. quintana, and E. chaffeensis were respectively 1.6 percent (7 samples); 1.1 percent (5 samples); 3.9 percent (17 samples); 13.7 percent (60 samples); 12.8 percent (56 samples), and 10.5 percent (46 samples). Frequent multiple/cross-reactivity was observed in this study. Age over 40 years old, urban profession, and rural residence were significantly associated with some but not all infections rate. Low seropositivity rates for R. rickettsii, R. typhi, and C. burnetii contrasted with higher rates of seropositivity for B. quintana, B. henselae, and E. chaffeensis. These results show that all tested rickettsial species or antigenically closely related possible exist in this particular region.

De William Osler a Michael Gottlieb e a descoberta da Aids: os relatos de casos e a importancia da pesquisa fenomenologica clinica na medicina / From William Osler to Michael Gottlieb and the discovery of Aids: Case reports and the importance of the clinical phenomenological research

O diagnostico clinico e sua divulgacao cientifica sao instrumentos antigos da cultura medica. Os medicos sempre foram apreciadores de relatos de casos quer informalmente, em conversas entre colegas, quer na formalidade das apresentacoes em congressos ou publicacoes cientificas. A essencia do relato de casos passa pelo diagnostico, a principal materia prima do trabalho medico, portanto algo que inevitavelmente este tem sua capacidade desenvolvida ao longo de sua formacao academica e profissional. Consistem, o diagnostico e por extensao os relatos de casos, em pratica quase que cotidiana de exercicio profissional, surgindo provavelmente dai o fascinio que desperta entre nos. Nem sempre considerado metodo cientifico de excelencia, principalmente por nao comportar analises quantitativas e conclusoes, representa importante exemplo de pesquisa fenomelogica, resultante de observacao direta do evento na natureza. A despeito de modismo cientificos e metodologicos continua tendo importancia capital no desenvolvimento da ciencia medica bem tipificada pela notavel identificacao da Aids em 1981. Dar continuidade a saga dos relatos cientificos de casos permanece um importante e historico dever dos medicos praticantes

Atypical fulminant Rickettsia rickettsii infection (Brazilian spotted fever) presenting as septic shock and adult respiratory distress syndrome

Brazilian spotted fever, caused by Rickettsia rickettsii, has been increasingly reported in Brazil especially in the southeastern states. The severe and fulminant forms of the disease are not unusual but most of the reported fatal cases have shown some typical clinical clue, which leads the attending physician to a correct diagnosis. We report a probable case of atypical fulminant Brazilian spotted fever that presented full-blown septic shock associated with Adult Respiratory Distress Syndrome (ARDS) and delayed uncharacteristic rash with an over four-fold increase in reciprocal IgM, but not IgG titer against Rickettsia rickettsii. Brazilian practitioners should be aware of the possibility of Brazilian spotted fever as a cause of fulminant primary sepsis with ARDS; improved laboratory methods are necessary for the rapid diagnosis of such cases.

Parinaud'S oculoglandular syndrome associated with paracoccidioidomycosis.

The authors report one case of Parinaud's oculoglandular syndrome associated with Paracoccidioides brasiliensis infection. No other medical report of this condition was found in the medical literature available at Index Medicus and Medline. The eye involvement has been rather uncommon in paracoccidioidomycosis and this report emphasizes the possibility of this kind of presentation making it also necessary to include paracoccidioidomycosis among the several known causes of Parinaud's oculoglandular syndrome.

Parinaud's oculoglandular syndrome associated with paracoccidioidomycosis

The authors report one case of Parinaud's oculoglandular syndrome associated with Paracoccidioides brasiliensis infection. No other medical report of this condition was found in the medical literature available at Index Medicus and Medline. The eye involvement has been rather uncommon in paracoccidioidomycosis and this report emphasizes the possibility of this kind of presentation making it also necessary to include paracoccidioidomycosis among the several known causes of Parinaud's oculoglandular syndrome

Isolamento de crioglobulina no soro e líquido sinovial em paciente com artrite associada a crioglobulina do tipo I, macroglobulinemia de Waldenström e amiloidose / Isolation of cryoglobulin in serum and synovial fluid in a patient with arthritis associated with type I cryoglobulinemia, Waldenström macroglobulinemia and amyloidosis

A associaçäo entre macroglobulinemia de Waldenström e crioglobulinemia IgM monoclonal é relativamente frequente, muito embora sejam incomuns os sintomas secundários à crioglobulinemia nesses casos. É relatado um caso de macroglobulinemia de Waldenström associado a crioglobulinemia, amiloidose e monoartrite com extenso derrame articular, em que foi isolada no sangue e líquido sinovial uma crioglobulina IgM lambda monoclonal. Tendo em vista a ausência de relatos na literatura sobre a associaçäo entre crioglobulinemia monoclonal e monoartrite com detecçäo da crioglobulina no líquido sinovial, os médicos devem estar atentos para esta possibilidade, especialmente porque näo existem dificuldades técnicas adicionais para a pesquisa e detecçäo de crioglobulinas no líquido sinovial

Crioglobulinemia: estudo imunoquímico de três pacientes / Cryoglobulinemia: immunochemical study of three patients

As crioglobulinas säo proteínas que se precipitam ao a frio e podem ser encontradas em várias doenças humanas. Sua detecçäo e estudo imunoquímico podem ser úteis para o diagnóstico e compreensäo de muitos estados patológicos. Säo descritos três diferentes casos de crioglobulenemia, cada um representativo dos tipos clássicos de Brouet. Um paciente apresentava crioglobulinemia do tipo I e linfoma plasmocitóide; näo tinha sintomas de criobulinemia propriamente ditos, a despeito dos altos níveis de crioglobulinas circulantes (IgG 3 K monoclonal). O paciente com crioglobulinemia do tipo II, crioglobulinemia essencial mista (IgM lambida monoclonal e IgG policlonais) era portador de leishmaniose mucocutânea. Näo foram encontradas hiperviscosidade sérica ou cristalocrioglobulinas em nenhum do casos. A temperatura de crioprecipitaçäo situou-se sempre abaixo de 20 graus e a concentraçäo das hipocrioglobulinas foi diferentes das respctivas crioglobulinas em dois pacientes, näo havendo relatos na literatura sobre este tipo de achado

Doença de Still do adulto: apresentaçäo de um caso / Adult Still's disease: report of one case

É relatado um caso de doença de Still do adulto (artrite reumatóide juvenil do adulto), síndrome clínica caracterizada por febre de origem indeterminada, poliartrite, serosite, erupçäo cutânea, faringite, leucocitose com predomínio de polimorfonucleares, provas inflamatórias agudas alteradas e ausência de evidências sugestivas de outras enfermidades, com fator reumatóide e anticorpos antinucleares tipicamente ausentes. Como näo existe anormalidade histológica ou laboratorial patogomônica, o diagnóstico é basicamente de esclusäo e o médicointernista deve estar familiarizado com a constelaçäo de anormalidades características desta doença