A case of chikungunya virus disease presenting with remarkable acute arthritis of a previously damaged finger joint.

Chikungunya virus (CHIKV) is a mosquito-borne arthritogenic alphavirus that has recently been introduced to Brazil. We report the case of a 36-year-old male patient from the City of Rio de Janeiro who developed molecularly-confirmed CHIKV disease and whose clinical picture was remarkable because of acute arthritis of an interphalangeal joint that had been damaged by trauma 8 years previously. This case illustrates that acute CHIKV disease may preferentially target previously damaged joints. Careful study of individual cases may provide valuable information on the presentation and management of this emerging zoonosis in Brazil.

A case of chikungunya virus disease presenting with remarkable acute arthritis of a previously damaged finger joint

Abstract: Chikungunya virus (CHIKV) is a mosquito-borne arthritogenic alphavirus that has recently been introduced to Brazil. We report the case of a 36-year-old male patient from the City of Rio de Janeiro who developed molecularly-confirmed CHIKV disease and whose clinical picture was remarkable because of acute arthritis of an interphalangeal joint that had been damaged by trauma 8 years previously. This case illustrates that acute CHIKV disease may preferentially target previously damaged joints. Careful study of individual cases may provide valuable information on the presentation and management of this emerging zoonosis in Brazil.

Lamb pays lip service: two cases of ecthyma contagiosum (orf).

Ecthyma contagiosum (orf) is caused by a parapox virus, which results in ulcerative stomatitis of mainly sheep and goats. The disease may be transmitted to humans through direct contact. Complications are rare in healthy individuals, who rarely report the disease. Two married, recreational sheep farmers, were bitten on their index fingers by an affected lamb. While the husband made an uneventful recovery after oral flucloxacillin, his wife was admitted to hospital with necrosis of her finger, cellulitis and lymphangitis requiring intravenous clindamycin. She subsequently developed a generalized maculo-papular rash, which was initially thought to be an adverse drug reaction, but, on hindsight, may have been erythema multiforme associated with orf. Orf is a common zoonosis, rarely reported in general practice. The disease is usually self-limiting and resolves in 6-8 weeks, but complications may occur. The diagnosis should be considered in at-risk occupational and religious groups.

Is injecting a finger with rabies immunoglobulin dangerous?

Treating potentially rabies virus infected wounds requires the injection of rabies immunoglobulin into and around the wounds, followed by vaccination with an approved tissue culture rabies vaccine. A significant number of such bite wounds involves fingers where there is little space for expansion. Injecting immunoglobulin into such areas under pressure may induce a compartment syndrome caused by compromising circulation. We carried out a retrospective review and a prospective study of patients seen with digital bite injuries and found that it is a safe procedure if carried out with care by experienced staff.

Human papilloma virus proliferation in a healing burn.

A 4-year-old boy sustained a superficial burn to his finger at the site of a viral papilloma. The burn was treated conservatively. During re-epithelialization the human papilloma virus (HPV) incorporated its genome in the regenerating cells, leading to a verruca as large as the original burn. Diagnosis was reinforced by a history from the patient's mother. Complete resolution of this complication was achieved with topical therapy.

Confirmation of hepatitis C virus transmission through needlestick accidents by molecular evolutionary analysis.

To document the transmission of hepatitis C virus (HCV) through needlestick accidents, 3 health workers who acquired HCV through such accidents and their HCV donor patients were studied using molecular evolutionary analysis based on the HCV E2 region. At least six clones were sequenced from each subject. Nucleotide substitutions were estimated by the six-parameter method, and a phylogenetic tree was constructed by the neighbor-joining method. HCV isolates from the donor patient and the recipient were nested in one monophyletic cluster; this clustering was confirmed to be statistically significant by bootstrap analysis. The nucleotide divergence among the isolates from the recipient was always smaller than that from the donor, supporting the notion that the direction of transmission was from the donor to the recipient. These findings provide evidence, at a molecular evolutionary level, that HCV was transmitted through needlestick accidents.