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2.
Am J Forensic Med Pathol ; 41(1): 48-51, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31977345

RESUMO

Chikungunya is a mosquito-transmitted viral illness with clinical hallmarks of rash, fever, arthralgia, and myalgia. It is rarely fatal, although vulnerable populations, to include elderly, children, and those with multiple comorbid illnesses, are more susceptible to severe infection and death. There have been multiple areas of the world with periodic chikungunya epidemics. With increased immigration, foreign travel, epidemics, and global spread of the virus, it is prudent to consider chikungunya as a diagnosis both clinically and postmortem when a patient presents with rash, fevers, and arthralgia. We present a case of a patient with recent foreign travel, a rash, fever, and arthralgia with mosquito bites who succumbed to chikungunya viral infection with pneumonia. His diagnosis was established postmortem. A review of the literature is included in this report. This case stresses the delayed time to diagnose chikungunya with serologic testing and the importance of using reverse transcriptase-polymerase chain reaction to aid in rapid and accurate diagnosis and management.


Assuntos
Febre de Chikungunya/diagnóstico , Doença Relacionada a Viagens , Artralgia/virologia , Vírus Chikungunya/genética , El Salvador , Doenças Endêmicas , Exantema/patologia , Exantema/virologia , Patologia Legal , Humanos , Los Angeles , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/etiologia , Reação em Cadeia da Polimerase , Edema Pulmonar/patologia , Edema Pulmonar/virologia
3.
Int J Infect Dis ; 86: 1-4, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31238155

RESUMO

OBJECTIVE: To evaluate the performance of an instrument for predicting chronic chikungunya arthritis (CCA) in adult patients. METHODS: A diagnostic test study was conducted and data from 217 confirmed cases of chikungunya virus (CHIKV) illness were analyzed. Two chronic chikungunya arthralgia scales (3-item CCAS-3 and 4-item CCAS-4) were constructed. RESULTS: Modest performance of the CCAS-3 scale was documented at the two given cut-off points. A CCAS-4 score ≥3 showed high sensitivity and specificity for predicting the persistence of CCA at 12 months after acute disease. CONCLUSIONS: If replicated in other populations, these results could be useful in the medical management of patients with symptomatic CHIKV infection.


Assuntos
Artrite/diagnóstico , Febre de Chikungunya/diagnóstico , Adulto , Artralgia/diagnóstico , Artralgia/virologia , Artrite/virologia , Febre de Chikungunya/virologia , Vírus Chikungunya/fisiologia , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
4.
J Med Case Rep ; 13(1): 120, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31043165

RESUMO

BACKGROUND: Although dengue viral infections have emerged as one of the most important mosquito-borne diseases, neurological manifestations of dengue infections are uncommon. Guillain-Barré syndrome and Miller Fisher syndrome have been reported to occur as immune-mediated complications following dengue infection. We report the case of a patient who developed Miller Fisher syndrome during the acute phase of dengue fever suggesting that Miller Fisher syndrome may arise as a result of direct neurotropism of the dengue virus. CASE PRESENTATION: A 70-year-old Sri Lankan man with well-controlled diabetes mellitus and hypertension presented with fever of 3 days' duration, drooping of eyelids, dysarthria, and unsteady gait. He developed bilateral asymmetric partial ptosis, complete external ophthalmoplegia, bilateral palatal palsy, unilateral tongue weakness, ataxia, and areflexia from the second day of illness. He did not have limb weakness. He had evidence of acute dengue infection including progressive thrombocytopenia and leukopenia, positive dengue non-structural protein 1 antigen, dengue immunoglobulin M antibodies, and polymerase chain reaction detection of dengue virus genome in serum. Magnetic resonance imaging of his brain and cerebrospinal fluid analysis were normal. Polymerase chain reaction for dengue virus and immunoglobulin M antibodies in cerebrospinal fluid were negative. Nerve conduction studies showed axonal neuropathy. Antibodies (immunoglobulin G, immunoglobulin M, and immunoglobulin A) against GQ1b and GT1a were negative. He was treated with intravenously administered immunoglobulins and a recommended fluid regimen for dengue fever. He made a complete recovery from dengue fever in 7 days and Miller Fisher syndrome in 20 days. CONCLUSIONS: This case report highlights the rare occurrence of Miller Fisher syndrome during the acute phase of dengue fever. Neurological manifestations may occur as a consequence of direct neurotropism of dengue virus.


Assuntos
Dengue/diagnóstico , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Síndrome de Miller Fisher/diagnóstico , Oftalmoplegia/diagnóstico , Idoso , Artralgia/etiologia , Artralgia/virologia , Dengue/complicações , Dengue/fisiopatologia , Diplopia/virologia , Febre/virologia , Humanos , Masculino , Síndrome de Miller Fisher/etiologia , Síndrome de Miller Fisher/fisiopatologia , Debilidade Muscular/virologia , Oftalmoplegia/etiologia , Oftalmoplegia/virologia , Resultado do Tratamento
5.
An Pediatr (Barc) ; 90(5): 280-284, 2019 May.
Artigo em Espanhol | MEDLINE | ID: mdl-31056091

RESUMO

INTRODUCTION: The aetiological agent of erythema infectiosum is Erythrovirus B19 (also known as parvovirus B19), frequently found in children and adolescents, but also associated with arthropathy, aplastic crisis, and abortion in adults. MATERIAL AND METHODS: A retrospective study of Erythrovirus B19 cases in the years 2010-2015. RESULTS: Of the 56 cases of Erythrovirus B19 diagnosed, 34 were adults (32 women and 2 men) and 22 younger than 18 years (12 girls and 10 boys). Six cases were in pregnant women. Infections mainly occurred between spring and summer. In childhood, fever (64%), rash (50%), and anaemia (55%) were the most frequent symptoms. However, arthralgia (59%) was the most frequent symptom in adults, and less frequent were anaemia (41%), fever (32%), and rash (29%). CONCLUSIONS: The characteristic clinical presentation in childhood was rash and fever, whereas in adults it was arthralgia. Anaemia is also frequent, but only severe in previous haematological disease. It should be pointed out that Erythrovirus B19 infection during pregnancy could severely affect the foetus.


Assuntos
Eritema Infeccioso/epidemiologia , Parvovirus B19 Humano/isolamento & purificação , Complicações Infecciosas na Gravidez/virologia , Adulto , Fatores Etários , Artralgia/epidemiologia , Artralgia/virologia , Criança , Pré-Escolar , Eritema Infeccioso/fisiopatologia , Exantema/epidemiologia , Exantema/virologia , Feminino , Febre/epidemiologia , Febre/virologia , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos
6.
Fisioterapia (Madr., Ed. impr.) ; 41(2): 107-111, mar.-abr. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183338

RESUMO

Antecedentes: La fiebre del chikungunya es una enfermedad vírica transmitida por mosquitos del género Aedes aegypti. Cursa con una fase aguda, en la que se presenta fiebre, exantemas y artralgias, y una fase crónica, en la que hay persistencia de artralgias incapacitantes, con un patrón poliarticular y distal; el tratamiento de la enfermedad es principalmente farmacológico y hay una baja evidencia sobre el tratamiento de las secuelas de la enfermedad. Objetivo: Evaluar el efecto de la intervención fisioterapéutica en un paciente con secuelas de chikungunya. Paciente: De género masculino, con 36 años, infectado con el virus en el 2015 y en el que persiste la artralgia, la disminución de la movilidad articular y el edema. Método: Se realiza una intervención fisioterapéutica durante 8 semanas con actividad física, modalidades terapéuticas e hidroterapia; al final de la intervención se evalúan los cambios. Conclusión: El programa propuesto permite disminuir el dolor y mejorar la movilidad articular y la capacidad funcional


Background: Chikungunya fever is a viral disease transmitted by mosquitoes of the genus Aedes aegypti. It has an acute phase in which there is fever, rashes and arthralgia, and a chronic phase in which there is a persistent disabling arthralgia, with a polyarticular and distal pattern. The treatment of the disease is mainly pharmacological, and there is little evidence about the treatment of the sequelae of the disease. Objective: To evaluate the effect of a physiotherapy intervention in a patient with chikungunya sequelae. Patient: Male, 36 years old, infected with the virus in 2015 and who has persistent arthralgia, decreased joint mobility, and oedema. Method: A physiotherapy intervention was performed for 8 weeks with physical activity, therapeutic modalities, and hydrotherapy. At the end of the intervention the changes were evaluated. Conclusion: The proposed program helped to reduce pain and improve joint mobility and functional capacity


Assuntos
Humanos , Masculino , Adulto , Febre de Chikungunya/complicações , Febre de Chikungunya/reabilitação , Artralgia/reabilitação , Artralgia/virologia , Manipulações Musculoesqueléticas/métodos , Técnicas de Exercício e de Movimento/métodos
7.
Viruses ; 11(3)2019 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-30909385

RESUMO

Arthritogenic alphaviruses are a group of medically important arboviruses that cause inflammatory musculoskeletal disease in humans with debilitating symptoms, such as arthralgia, arthritis, and myalgia. The arthritogenic, or Old World, alphaviruses are capable of causing explosive outbreaks, with some viruses of major global concern. At present, there are no specific therapeutics or commercially available vaccines available to prevent alphaviral disease. Infected patients are typically treated with analgesics and non-steroidal anti-inflammatory drugs to provide often inadequate symptomatic relief. Studies to determine the mechanisms of arthritogenic alphaviral disease have highlighted the role of the host immune system in disease pathogenesis. This review discusses the current knowledge of the innate immune response to acute alphavirus infection and alphavirus-induced immunopathology. Therapeutic strategies to treat arthritogenic alphavirus disease by targeting the host immune response are also examined.


Assuntos
Infecções por Alphavirus/tratamento farmacológico , Artralgia/tratamento farmacológico , Artralgia/virologia , Imunidade Inata , Inflamação/tratamento farmacológico , Alphavirus/efeitos dos fármacos , Infecções por Alphavirus/complicações , Infecções por Alphavirus/imunologia , Animais , Artrite/tratamento farmacológico , Artrite/virologia , Febre de Chikungunya/tratamento farmacológico , Vírus Chikungunya/efeitos dos fármacos , Ensaios Clínicos como Assunto , Modelos Animais de Doenças , Interações Hospedeiro-Patógeno/imunologia , Humanos , Camundongos , Mialgia/tratamento farmacológico , Mialgia/virologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-30455237

RESUMO

Chikungunya virus (CHIKV) causes a febrile disease associated with chronic arthralgia, which may progress to neurological impairment. Chikungunya fever (CF) is an ongoing public health problem in tropical and subtropical regions of the world, where control of the CHIKV vector, Aedes mosquitos, has failed. As there is no vaccine or specific treatment for CHIKV, patients receive only palliative care to alleviate pain and arthralgia. Thus, drug repurposing is necessary to identify antivirals against CHIKV. CHIKV RNA polymerase is similar to the orthologue enzyme of other positive-sense RNA viruses, such as members of the Flaviviridae family. Among the Flaviviridae, not only is hepatitis C virus RNA polymerase susceptible to sofosbuvir, a clinically approved nucleotide analogue, but so is dengue, Zika, and yellow fever virus replication. Here, we found that sofosbuvir was three times more selective in inhibiting CHIKV production in human hepatoma cells than ribavirin, a pan-antiviral drug. Although CHIKV replication in human induced pluripotent stem cell-derived astrocytes was less susceptible to sofosbuvir than were hepatoma cells, sofosbuvir nevertheless impaired virus production and cell death in a multiplicity of infection-dependent manner. Sofosbuvir also exhibited antiviral activity in vivo by preventing CHIKV-induced paw edema in adult mice at a dose of 20 mg/kg of body weight/day and prevented mortality in a neonate mouse model at 40- and 80-mg/kg/day doses. Our data demonstrate that a prototypic alphavirus, CHIKV, is also susceptible to sofosbuvir. As sofosbuvir is a clinically approved drug, our findings could pave the way to it becoming a therapeutic option against CF.


Assuntos
Antivirais/uso terapêutico , Febre de Chikungunya/tratamento farmacológico , Vírus Chikungunya/efeitos dos fármacos , Vírus Chikungunya/patogenicidade , Sofosbuvir/uso terapêutico , Replicação Viral/efeitos dos fármacos , Animais , Animais Recém-Nascidos , Artralgia/tratamento farmacológico , Artralgia/virologia , Febre de Chikungunya/virologia , Humanos , Masculino , Camundongos
10.
Am J Trop Med Hyg ; 100(2): 405-410, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30526743

RESUMO

From April to September 2017, Bangladesh experienced a huge outbreak of acute Chikungunya virus infection in Dhaka. This series describes the clinical and laboratory features of a large number of cases (690; 399 confirmed and 291 probable) suffered during that period. This observational study was carried out at Dhaka Medical College Hospital, Bangladesh. The median age of the patients at presentation was 38 years (IQR 30-50) with a male (57.3%) predominance. Hypertension and diabetes were the most common comorbidities. The mean (±SD) duration of fever was 3.7 (±1.4) days. Other common manifestations were arthralgia (99.2%), maculopapular rash (50.2%), morning stiffness (49.7%), joint swelling (48.5%), and headache (37.6%). Cases were confirmed by anti-chikungunya IgG (173; 43.3%), IgM (165; 42.3%), and reverse transcription polymerase chain reaction (44; 11.0%). Important laboratory findings include high erythrocyte sedimentation rate (156; 22.6%), raised serum glutamic pyruvic transaminase (73; 10.5%), random blood sugar (54; 7.8%), leukopenia (72; 10.4%), thrombocytopenia (41; 5.9%), and others. The oligo-articular (453; 66.1%) variety of joint involvement was significantly more common compared with the poly-articular (237; 34.5%) variety. Commonly involved joints were the wrist (371; 54.1%), small joints of the hand (321; 46.8%), ankle (251; 36.6%), knee (240; 35.0%), and elbow (228; 33.2%). Eleven cases were found to be complicated with neurological involvement and two of them died. Another patient died due to myocarditis. Public health experts, clinicians, and policymakers could use the results of this study to construct the future strategy tackling chikungunya in Bangladesh and other epidemic countries.


Assuntos
Anticorpos Antivirais/sangue , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/fisiopatologia , Vírus Chikungunya/imunologia , Surtos de Doenças , Doença Aguda , Adulto , Artralgia/epidemiologia , Artralgia/mortalidade , Artralgia/fisiopatologia , Artralgia/virologia , Bangladesh/epidemiologia , Febre de Chikungunya/mortalidade , Febre de Chikungunya/virologia , Vírus Chikungunya/genética , Vírus Chikungunya/isolamento & purificação , Comorbidade , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/mortalidade , Diabetes Mellitus/fisiopatologia , Diabetes Mellitus/virologia , Erupção por Droga/epidemiologia , Erupção por Droga/mortalidade , Erupção por Droga/fisiopatologia , Erupção por Droga/virologia , Feminino , Cefaleia/epidemiologia , Cefaleia/mortalidade , Cefaleia/fisiopatologia , Cefaleia/virologia , Humanos , Hipertensão/epidemiologia , Hipertensão/mortalidade , Hipertensão/fisiopatologia , Hipertensão/virologia , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Leucopenia/epidemiologia , Leucopenia/mortalidade , Leucopenia/fisiopatologia , Leucopenia/virologia , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Trombocitopenia/epidemiologia , Trombocitopenia/mortalidade , Trombocitopenia/fisiopatologia , Trombocitopenia/virologia
11.
Dermatol Clin ; 37(1): 95-105, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30466692

RESUMO

Chikungunya and Zika virus infections are emerging diseases in the Americas, and dengue continues to be the most prevalent arthropod-borne virus in the world. These arbovirus diseases may spread by endemic transmission or as travel-related infections and have rapidly expanded their geographic distribution secondary to vector spread. All 3 share a similar clinical picture that includes a maculopapular rash. Zika is characterized by pruritic rash, low-grade fever, and arthralgia. Congenital nervous system malformations are a growing public-health concern. Chikungunya distinctive dermatologic manifestations include facial melanosis and bullous eruption. Dengue bleeding complications may be life-threatening and require inpatient management.


Assuntos
Febre de Chikungunya/diagnóstico , Dengue/diagnóstico , Exantema/virologia , Infecção por Zika virus/diagnóstico , Artralgia/virologia , Febre de Chikungunya/complicações , Febre de Chikungunya/transmissão , Dengue/complicações , Dengue/prevenção & controle , Dengue/transmissão , Febre/virologia , Rubor/virologia , Cefaleia/virologia , Humanos , Mialgia/virologia , Infecção por Zika virus/complicações , Infecção por Zika virus/prevenção & controle , Infecção por Zika virus/transmissão
12.
Rev Esc Enferm USP ; 52: e03403, 2018 Nov 29.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30517293

RESUMO

OBJECTIVE: Describe the clinical-epidemiological profile of hospitalized elderly patients with arbovirus. METHOD: A documentary retrospective population-based descriptive study that used a quantitative approach with hospitalized elderly patients diagnosed with arbovirus was conducted in a teaching hospital. Data were collected from medical records and investigation forms. RESULTS: Thirty-three elderly patients participated in this study. A prevalence of dengue was observed, with fever, myalgia, and arthralgia. Arterial hypertension and diabetes were the comorbidities. Statistically significant correlations were obtained between arbovirus and schooling, employment situation, marital status, test results, and use of analgesics; and between the site of arthralgia and Chikungunya. CONCLUSION: The results support nursing care to hospitalized elderly patients with arbovirus, allowing the development of a proper and humanized care plan.


Assuntos
Febre de Chikungunya/epidemiologia , Dengue/epidemiologia , Hospitalização , Idoso , Idoso de 80 Anos ou mais , Artralgia/epidemiologia , Artralgia/virologia , Febre de Chikungunya/fisiopatologia , Dengue/fisiopatologia , Feminino , Febre/epidemiologia , Febre/virologia , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Mialgia/epidemiologia , Mialgia/virologia , Prevalência , Estudos Retrospectivos
13.
Am J Trop Med Hyg ; 99(5): 1321-1326, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30226143

RESUMO

When introduced into a naïve population, chikungunya virus generally spreads rapidly, causing large outbreaks of fever and severe polyarthralgia. We randomly selected households in the U.S. Virgin Islands (USVI) to estimate seroprevalence and symptomatic attack rate for chikungunya virus infection at approximately 1 year following the introduction of the virus. Eligible household members were administered a questionnaire and tested for chikungunya virus antibodies. Estimated proportions were calibrated to age and gender of the population. We enrolled 509 participants. The weighted infection rate was 31% (95% confidence interval [CI]: 26-36%). Among those with evidence of chikungunya virus infection, 72% (95% CI: 65-80%) reported symptomatic illness and 31% (95% CI: 23-38%) reported joint pain at least once per week approximately 1 year following the introduction of the virus to USVI. Comparing rates from infected and noninfected study participants, 70% (95% CI: 62-79%) of fever and polyarthralgia and 23% (95% CI: 9-37%) of continuing joint pain in patients infected with chikungunya virus were due to their infection. Overall, an estimated 43% (95% CI: 33-52%) of the febrile illness and polyarthralgia in the USVI population during the outbreak was attributable to chikungunya virus and only 12% (95% CI: 7-17%) of longer term joint pains were attributed to chikungunya virus. Although the rates of infection, symptomatic disease, and longer term joint symptoms identified in USVI are similar to other outbreaks of the disease, a lower proportion of acute fever and joint pain was found to be attributable to chikungunya virus.


Assuntos
Anticorpos Antivirais/sangue , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/imunologia , Vírus Chikungunya/imunologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artralgia/epidemiologia , Artralgia/virologia , Vírus Chikungunya/isolamento & purificação , Criança , Pré-Escolar , Surtos de Doenças , Características da Família , Feminino , Febre/epidemiologia , Febre/virologia , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Inquéritos e Questionários , Ilhas Virgens Americanas/epidemiologia , Adulto Jovem
14.
Am J Trop Med Hyg ; 99(5): 1327-1330, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30226152

RESUMO

The northeastern region of Brazil has faced in the last 2 years the largest outbreak of chikungunya virus (CHIKV) infection in its history. There are still few studies on kidney involvement in CHIKV. The aim of this study is to describe the impact of chronic kidney disease (CKD) on CHIKV clinical manifestations and outcome. This is a cross-sectional study conducted in the State of Ceara, northeastern Brazil, including all registered cases of CHIKV infection in the period from January 2016 to December 2017. Clinical manifestations were collected from the notification reports from official data bank from the State Secretary of Health of Ceara: National System of Diseases Notification and Laboratory Manager. A total of 182,731 cases were notified. Patients' mean age was 32.4 ± 14.6 years, and 62.2% were female. The most common clinical manifestations were fever (88.6%), headache (72.9%), intense arthralgia (69.5%), and myalgia (65.6%). Hospital admission was required for 3,080 cases (3.3%), and death occurred in 383 cases (0.2%). Chronic kidney disease was reported in 691 cases (0.3%). Patients with CKD had a higher frequency of almost all clinical manifestations, including fever, myalgia, exanthema, vomiting, nausea, back pain, conjunctivitis, arthritis, severe arthralgia, petechiae, and retro-orbital pain. They also had a significantly higher frequency of diabetes, hematological disorders, liver diseases, hypertension, peptic ulcer disease, and autoimmune diseases. Mortality was significantly higher among CKD patients than patients without CKD (3.0% versus 0.2%, P < 0.0001).


Assuntos
Febre de Chikungunya/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Insuficiência Renal Crônica/virologia , Adolescente , Adulto , Artralgia/epidemiologia , Artralgia/virologia , Brasil/epidemiologia , Febre de Chikungunya/complicações , Vírus Chikungunya/isolamento & purificação , Estudos Transversais , Feminino , Febre/epidemiologia , Febre/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/mortalidade , Estudos Retrospectivos , Adulto Jovem
15.
Transpl Infect Dis ; 20(6): e12978, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30120808

RESUMO

Chikungunya virus is a recent emerging arbovirus in Latin America, and the clinical manifestations can vary from fever and rash to severe chronic inflammatory arthritis. Few reports have been published regarding this infection in immunocompromised patients, including solid organ transplant recipients. We report a case series of solid organ transplant recipients with confirmed Chikungunya infection by positive reverse transcription polymerase chain reaction (RT-PCR), identified between January 2014 and December 2016. In addition, we conducted a literature review searching PubMed, EMBASE, and LILACS databases on Chikungunya infection in solid organ transplant recipients. Ten solid organ transplant recipients were included, consisting of 5 kidney, 4 liver, and 1 liver/kidney transplant recipient. Mean age of the transplant recipients was 47 years, and the most frequent symptoms of Chikungunya infection were arthralgia and fever. None of the patients required treatment in the intensive care unit, no deaths or graft rejection occurred. None of our patients had recurrent arthritis during 3-month follow-up period after the infection. Twenty-one cases of Chikungunya virus were identified in the literature review. Most cases had a benign clinical course with no severe complications, death, or chronic inflammatory arthritis. In conclusion, Chikungunya infection in solid organ transplant recipients has a benign course and has no chronic recurrent arthritis. It is possible that the immunosuppression regimen could decrease the risk of severe or chronic inflammatory manifestations in solid organ transplant recipients infected with Chikungunya.


Assuntos
Artralgia/epidemiologia , Febre de Chikungunya/epidemiologia , Vírus Chikungunya/isolamento & purificação , Transplante de Rim/efeitos adversos , Transplante de Fígado/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artralgia/diagnóstico , Artralgia/virologia , Febre de Chikungunya/diagnóstico , Febre de Chikungunya/virologia , Vírus Chikungunya/genética , Criança , Colômbia/epidemiologia , Feminino , Humanos , Transplante de Rim/métodos , Transplante de Fígado/métodos , Masculino , Pessoa de Meia-Idade , RNA Viral/isolamento & purificação , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Adulto Jovem
16.
BMJ Case Rep ; 20182018 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-29880618

RESUMO

A 33-year-old woman with history of HIV presented with 4 months of gradually progressing right hip pain and was found to have avascular necrosis (AVN) of both femoral heads. She had no other risk factors for AVN including sickle cell disease, systemic lupus erythematosus, prolonged steroid used or trauma. She initially failed conservative management and ultimately had bilateral hip core decompressions. After decompression therapy, the left femoral head collapsed and patient underwent a left total hip arthroplasty. Her postsurgical course was complicated by the left sciatic nerve neuropathy for which she is currently being managed with duloxetine. She has yet to follow-up with her orthopaedic surgeon for further evaluation.


Assuntos
Artralgia/etiologia , Artroplastia de Quadril , Necrose da Cabeça do Fêmur/etiologia , Infecções por HIV/complicações , Articulação do Quadril/diagnóstico por imagem , Radiografia , Adulto , Artralgia/diagnóstico por imagem , Artralgia/virologia , Feminino , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur/virologia , Infecções por HIV/fisiopatologia , Articulação do Quadril/virologia , Humanos , Complicações Pós-Operatórias , Fatores de Risco , Neuropatia Ciática , Resultado do Tratamento
17.
J Med Case Rep ; 12(1): 137, 2018 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-29759074

RESUMO

BACKGROUND: Dengue is an arboviral infection classically presenting with fever, arthralgia, headache, and rashes. It is hyperendemic in Sri Lanka and has a major impact on health. Neurological complications of dengue fever are rare but have been reported in the literature. CASE PRESENTATION: A 60-year-old Sri Lankan man presented with a history of fever, arthralgia, and generalized malaise of 2 days duration. A diagnosis of dengue was confirmed with leukopenia, thrombocytopenia, and positive NS1 antigen done on day 2 without evidence of hemoconcentration. On admission, our patient had weakness of the bilateral lower limbs, which progressed in an ascending pattern involving both upper limbs and neck muscles, requiring assisted ventilation. Electromyography confirmed a demyelinating polyneuropathy and cerebrospinal fluid showed albumincytological dissociation. He was treated with intravenous immunoglobulins and made an uneventful recovery. Subsequently, his immunoglobulin M test result for dengue virus was positive. CONCLUSIONS: Guillain-Barré syndrome is a rare but possible neurological sequel following dengue fever. In regions where dengue is hyperendemic, screening for dengue illness may be important in patients presenting with acute flaccid paralysis.


Assuntos
Dengue/complicações , Dengue/diagnóstico , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/virologia , Artralgia/etiologia , Artralgia/virologia , Dengue/tratamento farmacológico , Dengue/fisiopatologia , Febre , Síndrome de Guillain-Barré/tratamento farmacológico , Síndrome de Guillain-Barré/fisiopatologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Pessoa de Meia-Idade , Sri Lanka , Resultado do Tratamento
18.
PLoS One ; 13(4): e0196630, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29709007

RESUMO

BACKGROUND: Chikungunya virus (CHIKV) emerged in Aruba for the first time in 2014. We studied the clinical presentation of acute CHIKV infection and the contribution of serologic and molecular assays to its diagnosis. In a cohort of confirmed CHIKV cases, we analysed the frequency, duration and predictors of post-chikungunya chronic polyarthralgia (pCHIK-CPA), defined as joint pains lasting longer than 6 weeks or longer than 1 year. METHODOLOGY: Patient sera obtained within 10 days of symptom onset were tested for CHIKV, using an indirect immunofluorescence test for the detection of CHIKV-specific Immunoglobulin M (IgM) and post-hoc, by reverse-transcription polymerase chain reaction (RT-PCR). CHIKV was isolated from selected samples and genotyped. For confirmed CHIKV cases, clinical data from chart review were complemented by a Telephone survey, conducted 18-24 months after diagnosis. When joint pain was reported, the duration, presence of inflammatory signs, type and number of joints affected, were recorded. Joint involvement was scored according to the 2010 'American College of Rheumatology/ European League Against Rheumatism' criteria for seronegative rheumatoid arthritis (ACR-score). Risk factors for pCHIK-CPA were identified by logistic regression. PRINCIPAL FINDINGS: Acute CHIKV infection was diagnosed in 269 of 498 sera, by detection of IgM (n = 105), by RT-PCR (n = 59), or by both methods (n = 105). Asian genotype was confirmed in 7 samples. Clinical data were complete for 171 of 248 (69.0%) patients, aged 15 years or older (median 49.4 [35.0-59.6]). The female-to-male ratio was 2.2. The main acute symptoms were arthralgia (94%), fever (85%), myalgia (85%), headache (73%) and rash (63%). In patients with arthralgia (n = 160), pCHIK-CPA longer than 6 weeks was reported by 44% and longer than 1 year by 26% of cases. Inflammatory signs, stiffness, edema and redness were frequent (71%, 39% and 21%, respectively). Joints involved were knees (66%), ankles (50%), fingers (52%), feet (46%), shoulders (36%), elbows (34%), wrists (35%), hips (31%), toes (28.1%) and spine (28.1%). Independent predictors of pCHIK-CPA longer than 1 year were female gender (OR 5.9, 95%-CI [2.1-19.6]); high ACR-score (7.4, [2.7-23.3]), and detection of CHIKV-RNA in serum beyond 7 days of symptom onset (6.4, [1.4-34.1]. CONCLUSIONS: We identified 269 CHIKV patients after the first outbreak of Asian genotype CHIKV in Aruba in 2014-2015. RT-PCR yielded 59 (28%) additional CHIKV diagnoses compared to IgM antibody detection alone. Arthralgia, fever and skin rash were the dominant acute phase symptoms. pCHIK-CPA longer than 1 year affected 26% of cases and was predicted by female gender, high ACR-score and CHIKV-RNA detection beyond 7 days of symptom onset.


Assuntos
Artralgia/virologia , Febre de Chikungunya/complicações , Vírus Chikungunya/genética , Adolescente , Adulto , Anticorpos Antivirais/sangue , Artralgia/complicações , Artralgia/epidemiologia , Aruba , Febre de Chikungunya/epidemiologia , Doença Crônica , Estudos de Coortes , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Genótipo , Humanos , Imunoglobulina G/sangue , Articulações/patologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
19.
Arch Med Res ; 49(1): 65-73, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29703609

RESUMO

AIM OF THE STUDY: To assess the cumulative incidence and clinical markers associated with persistent arthralgia (PA) at 12 months from acute chikungunya virus (CHIKV) infection. METHODS: A multicenter retrospective cohort study was conducted in the state of Colima, Mexico, and 217 serologically confirmed cases of CHIKV infection were enrolled. Participants aged 15 years and older were interviewed on 6 months basis from acute illness onset and the main binary outcome was self-reported PA at 12 months. To assess clinical markers associated with PA we used a generalized linear model. The 2-item Patient Health Questionnaire (PHQ-2) was used to screen for depressive symptoms among PA-positive individuals. RESULTS: The cumulative incidence of PA was 31.8%. In the generalized linear model, individuals ≥40 years of age (risk ratio (RR) = 1.68; 95% confidence interval (CI), 1.10-2.55) and those with 8 or more arthralgia sites (RR = 2.91, 95% CI 1.87-4.53) at acute disease had a significantly increased risk of PA at 12 months from CHIKV infection. Self-reported arthralgia (any site) at 3 months post-infection, a sub-chronic clinical marker, was also associated with a significantly increased risk of long-term articular manifestations (RR = 7.06, 95% CI 2.97-16.81). Depressive symptoms (PHQ-2 score ≥3) were reported by 33.3% of PA-positive participants. CONCLUSIONS: Our findings suggest that chronic CHKV-related articular manifestations were a frequent event in the study sample and the impact on functional status was potential. These results may be useful in health care settings in the risk-stratification of PA after CHIKV infection.


Assuntos
Artralgia/epidemiologia , Artralgia/virologia , Febre de Chikungunya/patologia , Depressão/epidemiologia , Adolescente , Adulto , Idoso , Vírus Chikungunya , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Autorrelato , Inquéritos e Questionários , Adulto Jovem
20.
J Evid Based Integr Med ; 23: 2156587218757661, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29484895

RESUMO

Chikungunya viral fever results in extreme morbidity and arthralgia in affected individuals. Currently, modern medicines providing symptomatic relief for the acute febrile phase and the chronic arthritic phase are only options available. Traditional Indian medical system, however, uses specific formulations for treatment of this infection; one such polyherbal formulation used to treat the postpyretic phase of chikungunya is amukkara choornam. The current study was undertaken to study the efficacy of amukkara choornam in the treatment of chikungunya in C57BL/6J mice. The formulation when administered to chikungunya-infected mice relieved morbidity and joint swelling. Analysis of virus clearance in brain and joint tissues on formulation treatment revealed a direct correlation of viral load in brain to morbidity during infection; likewise, joint swelling receded prior to complete viral clearance explaining possible immunomodulatory effect of amukkara choornam. This study provides insight into the possible mode of action of amukkara choornam during chikungunya.


Assuntos
Artralgia/tratamento farmacológico , Febre de Chikungunya/tratamento farmacológico , Vírus Chikungunya/fisiologia , Extratos Vegetais/administração & dosagem , Withania/química , Animais , Artralgia/virologia , Febre de Chikungunya/virologia , Vírus Chikungunya/efeitos dos fármacos , Avaliação Pré-Clínica de Medicamentos , Feminino , Humanos , Índia , Masculino , Medicina Tradicional , Camundongos , Camundongos Endogâmicos C57BL , Morbidade , Carga Viral/efeitos dos fármacos
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