Afectación oftalmológica en el contexto de un síndrome de Sweet: comunicación de un caso y revisión de la literatura / Ocular involvement in a patient with Sweet syndrome: report of a case and review of the literatura

Presentamos el caso clínico de una mujer de 66 años que acudió a urgencias por lesiones cutáneas en miembros tanto superiores como inferiores, edema facial y enrojecimiento ocular, acompañados de conjuntivitis hemorrágica. Tras pautar corticoides sistémicos el cuadro se resolvió en una semana. La biopsia cutánea confirmó que se trataba de un síndrome de Sweet. El síndrome de Sweet es una enfermedad infrecuente y desconocida para la mayor parte de los oftalmólogos a pesar de cursar con manifestaciones oftalmológicas. La afectación ocular está presente en un tercio de los pacientes, siendo los más usuales la epiescleritis y la conjuntivitis. El diagnóstico de confirmación es histopatológico y se caracteriza por una rápida respuesta a los corticoides sistémicos

The case presented is a 66-year-old woman who attended the emergency department due to skin lesions on the limbs, facial oedema, and eye redness accompanied by haemorrhagic conjunctivitis. The symptoms resolved after one week of systemic steroid treatment. Skin biopsy confirmed Sweet syndrome. Sweet syndrome is rare disorder and unknown by most ophthalmologists despite its frequent ophthalmological manifestations. Ocular involvement is present in one third of patients, with episcleritis and conjunctivitis being the most repeated. Pathology findings confirm the diagnosis which is also characterised by a rapid response to systemic corticosteroids

Effects of Floods on the Incidence of Acute Hemorrhagic Conjunctivitis in Mengshan, China, from 2005 to 2012.

This study aimed to examine the association between floods and the morbidity of acute hemorrhagic conjunctivitis (AHC) in Mengshan, China. Relying on the longitudinal data, a generalized additive model (GAM) was applied to quantify the relationship between the morbidity of AHC and floods from 2005 to 2012, controlling for other meteorological variables. Years lived with disability (YLDs) and attributable YLDs were used as the measure of the burden of AHC because of the floods. Multivariable analysis showed that floods were significantly associated with an increased risk of the morbidity of AHC (rate ratio [RR] = 2.136, 95% CI: 2.109-2.163). The total YLDs per 1,000 in Mengshan was 0.2001, although the value in females was higher than that in males (0.2351 versus 0.1686). The YLD per 1,000 of AHC in Mengshan was highest between the ages of 5 and 14 years (0.6530), followed by the age of 0-4 years (0.3325). The attributable YLD per 1,000 of AHC due to the floods in Mengshan was 0.0434 (95% CI: 0.0425-0.0442). Our study confirms that floods have significantly increased the risks of AHC in the selected study area. Females and youngsters may be the vulnerable populations to develop the flood-related disease.

2012 outbreak of acute haemorrhagic conjunctivitis in Indian Ocean Islands: identification of Coxsackievirus A24 in a returned traveller.

In May 2012, a Coxsackievirus A24 haemorrhagic conjunctivitis was diagnosed in Marseille, France, in a traveller returning from the Comoros Islands. This case allowed identification of the cause of an ongoing outbreak of haemorrhagic conjunctivitis in Indian Ocean Islands, illustrating that returning travellers may serve as sentinels for infectious diseases outbreaks in tropical areas where laboratory investigation is limited.

Conjunctivitis outbreak among divers.

In March 2006, an outbreak of conjunctivitis that occurred over a six day period among twenty-nine individuals who partook in recreational scuba diving trips on two boats off Vitu Levu Island, Fiji. We investigated the likelihood that a communal container used to store diving masks facilitated the spread of conjunctivitis among individuals. The diagnosis of conjunctivitis was based on clinical assessment by a physician. Transmission of conjunctivitis from person to person was documented with eventual identification of the index case, the dive master, a Fijian resident. Topical antibiotics were dispensed accordingly and detergent and bleach were used as mask cleaning agents in an effort to control the outbreak. Follow up surveys were mailed to all twenty-nine participants. Ultimately, fourteen cases of conjunctivitis were documented (46.7%). Eleven cases were verified during the six days in Fiji, two upon arrival back in the U.S., and one case of familial transmission in the U.S. All but two cases resolved within one week. Unknown to these divers was a coincidental, generalized outbreak of acute haemorrhagic conjunctivitis among the Fijian Residents. The communal container used to store diving masks was the likely vector for the spread of infectious conjunctivitis, the first such documented outbreak involving communal diving equipment.

Laboratory results in ocular viral diseases: implications in clinical-laboratory correlation

PURPOSE: To document etiology and predictive value of clinical diagnosis in laboratory confirmed viral diseases. METHODS: Reports of culture-positive cases of samples collected from patients presenting from January 1987 - December 2001 were evaluated. RESULTS: One thousand nine hundred and sixty-four (1964) cultures were submitted during 1987-2001. Twenty-six percent were positive (514). Human herpesvirus 1 was the most frequent agent isolated from all positive culture (56 percent). Adenovirus was the most common virus isolated from conjunctiva (66 percent), human herpesvirus 1 from lid and cornea (76 percent, 88 percent) and cytomegalovirus from vitreous (27 percent). Some unusual pathogens were recovered from conjunctiva as cytomegalovirus and from cornea as adenovirus, enterovirus and cytomegalovirus. Recognition of common viral syndromes was human herpesvirus 1 (88 percent), epidemic keratoconjunctivitis (88 percent), acute hemorrhagic conjunctivitis (70 percent) and varicella zoster virus (100 percent). However, some misdiagnosed cases were observed. Thirteen percent of conjunctivitis thought to be caused by herpes were due to adenovirus, 3.2 percent to Enterovirus, 3.2 percent to varicella zoster virus and 3.2 percent to human cytomegalovirus. Also, 5 percent of cases with a clinical diagnosis of herpes keratitis were caused by adenovirus and 2.7 percent by enterovirus. Finally, 4.8 percent of cases thought to be adenovirus conjunctivitis were herpes conjunctivitis. CONCLUSIONS: Human herpesvirus 1 remains the most frequently isolated virus from ocular sites in general (56 percent). Nonherpetic corneal isolates were in decreasing order: adenovirus, enterovirus and cytomegalovirus. Clinical and laboratory correlation was less than 90 percent. The most misdiagnosed cases were herpes conjunctivitis and keratitis, some cases of adenovirus conjunctivitis some cases of acute hemorrhagic conjunctivitis. It is essential that a rapid and...

OBJETIVOS: Documentar a etiologia e prever a importância do diagnóstico clínico em doenças virais oculares confirmadas em laboratório. MÉTODOS: Todos os relatórios de pacientes com cultura viral positiva durante o período de janeiro 1987 - dezembro 2001 foram analisados. RESULTADOS: Quinhentos e quatorze (514) casos foram encontrados. Em geral, herpesvírus 1 humano foi o agente mais freqüentemente isolado. Adenovírus foi o vírus mais comumente isolado da conjuntiva (66 por cento), herpesvírus 1 humano das pálpebras e córnea (76 por cento, 88 por cento respectivamente) e citomegalovírus do vítreo (27 por cento). Alguns agentes não usuais foram isolados da conjuntiva como citomegalovírus e da córnea como adenovírus, enterovírus e citomegalovírus. Reconhecimento das síndromes virais comuns foi: herpervírus 1 humano (88 por cento), ceratoconjuntivite epidêmica (88 por cento), conjuntivite aguda hemorrágica (70 por cento). Porém, alguns casos com diagnóstico incorreto foram observados. Treze por cento das conjuntivites com diagnóstico de herpes foram causadas por adenovírus, 3,2 por cento por enterovírus, 3,2 por cento por varicella zoster vírus e 3,2 por cento por citomegalovírus. Também, 5 por cento dos casos com diagnóstico clínico de ceratite herpética eram adenovírus e 2,7 por cento enterovírus. Além disso, 4,8 por cento dos casos em que se pensaram em conjuntivite por adenovírus, eram conjuntivite por herpes. Finalmente, 30 por cento dos casos em que se diagnosticaram conjuntive hemorrágica aguda, o agente etiológico era adenovírus. CONCLUSÃO: Em geral herpesvírus humano 1 continua a ser o vírus mais comum encontrado nas infecções oculares (56 por cento). Agentes não herpéticos isolados da córnea foram em ordem decrescente: adenovírus, enterovírus e citomegalovírus. A correlação entre o diagnóstico clínico e laboratorial foi menor do que 90 por cento. Um diagnóstico rápido e específico é essencial em casos de apresentações virais atípicas...

Complex extra-intestinal complications of ulcerative colitis in a patient with alpha1-antitrypsin deficiency.

Ulcerative colitis (UC) can manifest with a variety of extra-intestinal disorders frequently affecting the skin, joints, and liver. An aetiologic role of alpha1-antitrypsin deficiency in chronic inflammatory bowel disease has recently been suggested. We report a patient with UC and alpha1-antitrypsin deficiency who presented with disseminated cutaneous leucocytoclastic vasculitis clinically appearing with target-like purpuric patches and haemorrhagic oedemas. In addition, he displayed acute haemorrhage of the eyes and the respiratory tract consistent with a systemic vasculitic process. Moreover, he had autoimmune haemolytic anaemia. Systemic vasculitides, such as Wegener's granulomatosis, Churg-Strauss syndrome, and microscopic polyangiitis, could widely be excluded. Systemically administered glucocorticosteroids and azathioprine led to dramatic improvement of extra-intestinal symptoms. On the basis of alpha1-antitrypsin deficiency and UC, the present patient likely developed severe systemic vasculitis with multi-organ involvement. UC should at times be viewed within the context of a more generalized immune imbalance affecting multiple organs, and not as an isolated pathological entity. Testing for alpha1-antitrypsin deficiency in UC patients may detect individuals at higher risk of severe extra-intestinal involvement.

Enterovirus 70 binds to different glycoconjugates containing alpha2,3-linked sialic acid on different cell lines.

Enterovirus 70 (EV70), the causative agent of acute hemorrhagic conjunctivitis, exhibits a restricted tropism for conjunctival and corneal cells in vivo but infects a wide spectrum of mammalian cells in culture. Previously, we demonstrated that human CD55 is a receptor for EV70 on HeLa cells but that EV70 also binds to sialic acid-containing receptors on a variety of other human cell lines. Virus recognition of sialic acid attached to underlying glycans by a particular glycosidic linkage may contribute to host range, tissue tropism, and pathogenesis. Therefore, we tested the possibility that EV70 binds to alpha2,3-linked sialic acid, like other viruses associated with ocular infections. Through the use of linkage-specific sialidases, sialyltransferases, and lectins, we show that EV70 recognizes alpha2,3-linked sialic acid on human corneal epithelial cells and on U-937 cells. Virus attachment to both cell lines is CD55 independent and sensitive to benzyl N-acetyl-alpha-D-galactosaminide, an inhibitor of O-linked glycosylation. Virus binding to corneal cells, but not U-937 cells, is inhibited by proteinase K, but not by phosphatidylinositol-specific phospholipase C treatment. These results are consistent with the idea that a major EV70 receptor on corneal epithelial cells is an O-glycosylated, non-glycosyl phosphatidylinositol-anchored membrane glycoprotein containing alpha2,3-linked sialic acid, while sialylated receptors on U-937 cells are not proteinaceous.

Acute hemorrhagic conjunctivitis epidemic--2003 in Nepal.

This rapid communication present the findings of nationwide outbreak of acute hemorrhagic conjunctivitis (AHC) epidemic occurred in Nepal during summer 2003. Only ten percent of samples showed bacterial and no fungus were grown. On the contrary, viruses were detected in 60.0% cases studied. Of the viruses detected, Adenovirus (ADV), Coxsackie virus (CA24v) and both accounted for 83.3% (30/36), 11.1% (4/36) and 5.5% (2/36), respectively. Interestingly, ADV was detected also from one of the ten a Rupees bill.

Conjuntivitis hemorrágica aguda en Costa Rica y el origen del Enterovirus 70 en humanos / Acute hemorrhagic conjuntivitis in Costa Rica and the origen of enterovirus 70 in humans

Este estudio presenta la evidencia clínica y serológica de la epidemia de conjuntivitis hemorrágica aguda (CHA) que ocurrió en Puriscal, entre de 1981 y 1982 además de presentar la epidemiología en los años siguientes a su primera aparición y se discute sobre el origen del enterovirus 70, el agente etiológico más frecuente de esta entidad clínica. Las características clínicas encontradas fueron similares a otros estudios. En todas las personas estudiadas, al igual que en el personal de campo y de laboratorio, se detectó seroconversión, e infección subclínica. Seis meses después del primer caso de CHA, se determinó un 43 por ciento de seropositividad en 100 sueros recolectados de la población general en Puriscal. Esta virosis se presenta en forma endémica en Costa Rica, presentándose los picos endememicos cada dos o tres años, con una estacionalidad marcada en los meses de octubre, noviembre y diciembre. Existen varias posiblidades sobre el origen del enterovirus 70; uno de ellas es que el virus se haya derivado de algún otro enterovirus humano que afecte la conjuntiva, o pudo haber existido como una forma no patogénica. También se ha sugerido que el EV-70 pudo haberse derivado de un picornavirus de un invertebrado con un insecto, ya que este virus tiene diferencias muy importantes con el resto de los enterovirus humanos. Hasta el momento no hay evidencia para probar ninguna de estas posibilidades, pero en todo caso, el virus tuvo que haber sufrido una mutación para adquirir la patogenicidad en humanos. Estudios filogénticos han demostrado que el enterovirus 70 se origina de un ancestro común y en la actualidad circulan diferentes cepas que varían antigénicamente entre sí. Palabras claves: Conjunivitis hemorrágica aguda, Enterovirus 70, endémico y estacional, Costa Rica, zoonosis.

Acute hemorrhagic conjunctivitis due to enterovirus 70 in India.

An outbreak of acute hemorrhagic conjunctivitis occurred in Delhi, India, during August and September 1996. The etiologic agent was confirmed as enterovirus type 70 by a modified centrifugation-enhanced culture method followed by immunofluorescence and neutralization tests. After nearly a decade, this virus is reemerging as a cause of acute hemorrhagic conjunctivitis in India.

Etiología, clínica y evolución de la epidemia de conjuntivitis hemorrágica aguda en el Hospital Nacional Edgardo Rebagliati Martins, asociado al fenómeno "El Niño" entre Enero y Marzo de 1998

El propósito del presente trabajo fue determinar las características clínicas, epidemiológicas y de diagnóstico etiológico de la epidemia de Conjuntivitis Hemorrágica Aguda (CHA) que afectó a 714 personas entre personal asistencial y administrativo del Hospital Nacional Edgardo Rebliati Martins, en Lima, Perú, durante los meses de enero a marzo de 1998, en asociación con el Fenómeno del Niño, el cual es considerado como el sistema de variación climática más prominente, asociado con eventos extremos. El estudio realizado fue de tipo transversal, observacional, teniendo como criterio de exclusión el uso previo de automedicación, quedando un grupo de 50 pacientes, a los que se les realiza un estudio clínico y se procede a la detección del agente etiológico. Mediante pruebas de laboratorio. Se determinó que el periodo de incubación era de 24 a 48 horas con un pico máximo de 24 horas en el 90 por ciento. Los síntomas más frecuentes fueron: ardor 86 por ciento, dolor 74 por ciento, fotofobia 54 por ciento y prurito 32 por ciento. Los signos más frecuentes fueron: secreción conjuntival 100 por ciento, reacción folicular 100 por ciento y hemorragia subconjuntival 95 por ciento. Los síntomas remitieron, con resolución total al 5º día en el 95 por ciento. Los grupos laborales afectados fueron: técnicos de enfermería 44 por ciento, enfermeros 30 por ciento, personal administrativo 8 por ciento, médicos 6 por ciento y otros 12 por ciento. Los cultivos celulares en HEP-2 Ca.de laringe, dieron 41 por ciento de efecto citopático positivo a enterovirus, que al tipificarse mediante inmunofluorescencia indirecta, dio como resultado, ENTEROVIRUS 70 como agente etiológico de esta epidemia de CHA. En los exámenes de laboratorio no se encontraron hongos ni gérmenes comunes, requiriendo solo tratamiento sintomático y control de su diseminación especialmente en los hospitales y durante alteraciones climáticas severas como el fenómeno "El Niño". Palabras clave: Conjuntivitis Hemorrágica Aguda; Epidemia; Infecciones por enterovirus; Epidemiología - Perú. Infecciones Intrahospitalaria, Fenómeno "El Niño".

IgA secretora en lagrimas de pacientes con conjuntivitis hemorragica por Coxsackie A 24 / Secretory IgA in tears in patients with Coxsackie A 24 hemorrhagic conjunctivitis

Se estudiaron 177 pacientes en edades comprendidas entre 3 y 16 años afectados de conjuntivitis hemorrágica producida por el virus Coxsackie A 24. Se tomaron muestras de lágrimas a todos lo pacientes y se cuantificóIgA secretora, título de anticuerpos neutralizantes contra el virus y el pH de la lágrima. La IgA secretora detectada en la fase aguda confirió poca protección demostrada por bajo el título de anticuerpos neutralizantes contra el virus. En cambio, en la segunda muestra tomada a los 30 días se encuentra un incremento significativo del título de anticuerpos específicos. En la mayoría de los pacientes el pH disminuyó o permaneció constante a los 30 días

IgA secretora en lagrimas de pacientes con conjuntivitis hemorragica por Coxsackie A 24 / Secretory IgA in tears in patients with Coxsackie A 24 heorrhagic conjunctivitis

Se estudiaron 177 pacientes en edades comprendidas entre 3 y 16 años afectados de conjuntivitis hemorrágica producida por el virus Coxsackie A 24. Se tomaron muestras de lágrimas a todos lo pacientes y se cuantificóIgA secretora, título de anticuerpos neutralizantes contra el virus y el pH de la lágrima. La IgA secretora detectada en la fase aguda confirió poca protección demostrada por bajo el título de anticuerpos neutralizantes contra el virus. En cambio, en la segunda muestra tomada a los 30 días se encuentra un incremento significativo del título de anticuerpos específicos. En la mayoría de los pacientes el pH disminuyó o permaneció constante a los 30 días (AU)

[An etiology study on the 1986 epidemic of acute hemorrhagic conjunctivitis in China].

An epidemic of Acute Hemorrhagic Conjunctivitis (AHC) broke out in Shanghai, Henan and Fujian provinces of China in 1986. Twenty four strains of etiologically suspected virus were then isolated but not correctly identified. In 1990 9 out of 24 strains from these three places were re-examined by us in our laboratory, and found feasible to be neutralized by CA 24V antiserum, but not by antiserum to EV 70 as once reported by Henan. It was also found that these viruses (one strain from each of these three places) produced pathogenic changes in suckling mice, showed definite immuno-fluorescence with Mcabs, and were neutralized by McAbs against CA 24V which was isolated from Beijing by our laboratory in 1988. It is evident that all the isolates isolated from Shanghai, Henan and Fujian provinces in 1986 were Coxsackie-virus A 24 variant (CA 24V).

[Study on rapid diagnosis of acute hemorrhagic conjunctivitis caused by Coxsackievirus A24 variant].

An pandemic of acute hemorrhagic conjunctivitis (AHC) caused by Coxsackievirus A 24 variant (CA 24v) occurred in China in 1988. Rapid diagnosis of AHC was investigated by immunofluorescence technique. The bacteria-free conjunctival swab samples were inoculated into HeLa cell monolayer. The Virus-specific antigens in infected cells were examined by indirect immunofluorescence test. Of 35 samples, 17 was identified as CA 24v. The results of isolation and typing could be obtained with in 5 days. Further, CA 24v antigen in infected conjunctival cells were examined by indirect immunofluorescence test. Of 48 smears of conjunctival cells, 39 was positive. Positive rate were 81.3%.

Algunos factores clínico-epidemiológicos y causa de un brote de conjuntivitis hemorrágica aguda epidémica en Bluefields: Nicaragua, abril-junio de 1987 / Some clinical-epidemiologic factors and cause of an outbreak of epidemic acute hemorrhagic conjuntivitis in Bluefields: Nicaragua, April-June, 1987

Se realiza un estudio de un brote de conjuntivitis hemorrágica aguda epidérmica en la ciudad costera de Bluefields, ocurrido durante los meses de abril-junio de 1987. Se estudia la distribución del universo (619 pacientes) por edad, sexo y áreas geográficas de procedencia. Se estudiaron, además, 300 pacientes escogidos al azar para profundizar en otras variables como: frecuencia de síntomas y signos, ocupación y hacinamiento. Fue estudiada la causa del brote por cultivo virológico y reacciones serológicas de un grupo de pacientes; se identificó el virus Coxsackie A 24 como el agente causal de la epidemia. La tasa de ataque fue de 271,5 x 10 000 habitantes con la mayor afectación en el grupo de 15-29 años; el sexo femenino fue el de mayor participación porcentual y el hacinamiento estuvo presente en una proporción significativa de los pacientes afectados

Algunos factores clínico-epidemiológicos y causa de un brote de conjuntivitis hemorrágica aguda epidémica en Bluefields: Nicaragua, abril-junio de 1987 / Soe clinical-epidemiologic factors and cause of an outbreak of epidemic acute hemorrhagic conjuntivitis in Bluefields: Nicaragua, April-June, 1987

Se realiza un estudio de un brote de conjuntivitis hemorrágica aguda epidérmica en la ciudad costera de Bluefields, ocurrido durante los meses de abril-junio de 1987. Se estudia la distribución del universo (619 pacientes) por edad, sexo y áreas geográficas de procedencia. Se estudiaron, además, 300 pacientes escogidos al azar para profundizar en otras variables como: frecuencia de síntomas y signos, ocupación y hacinamiento. Fue estudiada la causa del brote por cultivo virológico y reacciones serológicas de un grupo de pacientes; se identificó el virus Coxsackie A 24 como el agente causal de la epidemia. La tasa de ataque fue de 271,5 x 10 000 habitantes con la mayor afectación en el grupo de 15-29 años; el sexo femenino fue el de mayor participación porcentual y el hacinamiento estuvo presente en una proporción significativa de los pacientes afectados