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2.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334773

RESUMO

The aetiology of febrile exanthems in children is often difficult to distinguish clinically. A diagnosis of Kawasaki disease (KD) should be considered in infants with exanthematous fever. More perplexing is the increasing incidence of an atypical form of KD. Pathogenesis of KD remains unclear even though an aberrant response of the immune system to an unidentified pathogen is often hypothesised. A 30-fold increase in the incidence of KD in Italy during the SARS-CoV-2 pandemic suggests an immune response to a viral trigger. We report an infant clinically diagnosed with high probability as incomplete KD, who presented with reactivation of the BCG injection site even though fever with rash was only less than 3 days duration. Echocardiography confirmed coronary artery abnormalities and prompt treatment with intravenous immunoglobulin facilitated rapid recovery. Physicians should consider a diagnosis of KD if BCG site reactivation is noted in children presenting with febrile exanthema.


Assuntos
Exantema/etiologia , Síndrome de Linfonodos Mucocutâneos/complicações , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Vacina BCG/administração & dosagem , Febre , Humanos , Fatores Imunológicos/uso terapêutico , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Vacinação/efeitos adversos , gama-Globulinas/uso terapêutico
3.
Praxis (Bern 1994) ; 109(15): 1179-1181, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33234038

RESUMO

CME Dermatology 22/Answers: Measles - Empidemiology and Clinical Manifestations Abstract. Measles is a highly contagious, acute and febrile illness that results from infection with measles virus. The World Health Organization (WHO) estimates a worldwide prevalence of ten million patients per year, leading to approximately 142 000 deaths (case fatality rate 1.4 %). The illness begins with fever, malaise and typically with at least one of the following signs: cough, coryza and/or conjunctivitis. Three to four days later, the characteristical rash appears. The primary clinical diagnosis needs to be confirmed by detection of specific IgM antibodies in serum or viral RNA by a throat swap. The management mainly consists of supportive therapy, a specific antiviral treatment does not exist. Therefore, prevention by widespread measles vaccination has absolute priority.


Assuntos
Dermatologia , Exantema , Sarampo , Exantema/etiologia , Humanos , Sarampo/diagnóstico , Sarampo/epidemiologia , Vírus do Sarampo , Vacinação
4.
J Assoc Physicians India ; 68(11): 77-78, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33187046

RESUMO

Rash associated with a febrile illness often poses challenges in diagnosis. The clinical knowledge of pathogenesis, onset and characteristics of rash is therefore essential to make an early diagnosis and for successful management of the disease. We present herewith a case of a young man with acute febrile illness and rash which raised doubts with regards to the possible etiological diagnosis and necessitated detailed work up which revealed a diagnosis of COVID-19. The case is being highlighted as often the history and clinical presentation may seem to be obvious but an atypical uncommon presentation which in this case was a maculopapular rash may not fit the picture of a single etiological diagnosis according to the known medical literature.


Assuntos
Infecções por Coronavirus , Exantema , Pandemias , Pneumonia Viral , Betacoronavirus , Exantema/etiologia , Febre/etiologia , Humanos , Masculino
5.
J Med Case Rep ; 14(1): 216, 2020 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-33168054

RESUMO

BACKGROUND: Several recent studies suggest the possibility of a skin rash being a clinical presentation of coronavirus disease 2019 (COVID-19). The purpose of this case report is to bring attention to skin manifestations in the early stage of COVID-19 in order to support frontline physicians in their crucial activity of case identification. CASE PRESENTATION: The patient is an Italian 32-year-old female nurse who had several close contacts with multiple patients with COVID-19 as part of her professional workload. On March 13, 2020, the patient developed an itchy, erythematous papular rash (sparing only her face, scalp, and abdomen), which lasted for 10 days. The rash was accompanied by a feeling of general fatigue that gradually worsened over the following days and has continued for 5 months (until the end of July 2020). During the first week of remote assessment carried out by her general practitioner, the patient gradually developed a dry cough, intermittent fever, and diarrhoea and then had a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Her skin manifestations disappeared completely 48 days after the onset of the disease, followed by the disappearance of the dry cough. CONCLUSIONS: In light of recent studies, this case report suggests that skin manifestations, when taken into account with other situational factors (such as profession and patient history) should be taken into proper consideration by frontline physicians as possibly being caused by SARS-CoV-2. Early identification of COVID-19 is a key part of the strategy of case detection and case isolation. To enhance this activity, further research is needed to establish frequency, symptoms, signs, and pathogenesis of skin manifestations in patients with COVID-19.


Assuntos
Infecções por Coronavirus/complicações , Exantema/etiologia , Pneumonia Viral/complicações , Prurido/etiologia , Adulto , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Fatores de Risco
8.
Rev. clín. med. fam ; 13(3): 235-239, oct. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-195076

RESUMO

La infección por SARS-CoV-2 se caracteriza por manifestaciones múltiples, entre las que las más habituales son la fiebre, la tos y la dificultad respiratoria. Sin embargo, se ha observado la presencia, cada vez más frecuente, de diferentes lesiones cutáneas que pueden persistir durante el curso de toda la enfermedad, constituyendo la principal o única sintomatología en determinados casos. No se ha demostrado que la presencia ni el grado de afectación de estas manifestaciones cutáneas estén relacionados con el pronóstico. Presentamos el caso de una mujer de 25 años, con fiebre de cinco días de evolución, acompañada de clínica respiratoria. Tras la desaparición de dicha sintomatología, comenzó con un exantema maculopapular, de doce días de duración. La aparición de nuevas enfermedades, especialmente con la gravedad e importancia epidemiológica de la infección ocasionada por SARS-CoV-2, obliga al especialista en Medicina de Familia a considerar en su sospecha diagnóstica cualquier tipo de sintomatología, aunque no se incluya entre la que habitualmente caracteriza a la nueva patología


SARS-CoV-2 virus infection is characterized by multiple manifestations, among which fever, cough, and shortness of breath are the most frequent. However, an increasing presence of different skin lesions has been observed, which may persist over the whole course of the disease, and which in certain cases are the main or only symptom. The connection of the presence or the degree of affectation of these cutaneous manifestations with prognosis has not been confirmed. We present the case of a 25-year-old woman, who had had fever for five days, together with respiratory symptoms. After those symptoms had resolved, a maculopapular rash appeared, lasting for twelve days. The emergence of new diseases, especially those with the severity and epidemiological significance of the SARS-CoV-2 infection, compels the Family Medicine specialist to consider any type of symptomatology in their suspected diagnosis, even if it is not included among the usual symptoms of the new disease


Assuntos
Humanos , Feminino , Adulto , Infecções por Coronavirus/complicações , Urticaria Pigmentosa/etiologia , Exantema/etiologia , Dermatite Atópica/complicações , Controle de Doenças Transmissíveis/organização & administração , Pandemias , Atenção Primária à Saúde
9.
J Drugs Dermatol ; 19(9): 858-864, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-33026745

RESUMO

As the coronavirus epidemic continues, a host of new cutaneous complications is seen on the faces of frontline healthcare workers wearing personal protective equipment on a daily basis. To minimize the risk of COVID-19 infection, healthcare workers wear tight-fitting masks that lead to an excessive amount of pressure on the facial skin. Mechanical pressure, mask materials, and perspiration can all lead to various types of cutaneous lesions such as indentations of the face, skin tears, post-inflammatory hyperpigmentation, ulceration, crusting, erythema, and infection. The objective of this article is to provide effective and straightforward recommendations to those health care providers using facial masks in order to prevent skin-related complications. J Drugs Dermatol. 2020;19(9):858-864. doi:10.36849/JDD.2020.5259.


Assuntos
Infecções por Coronavirus/prevenção & controle , Dermatoses Faciais/etiologia , Traumatismos Faciais/etiologia , Máscaras/efeitos adversos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/efeitos adversos , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/epidemiologia , Eritema/etiologia , Eritema/fisiopatologia , Exantema/etiologia , Exantema/fisiopatologia , Dermatoses Faciais/fisiopatologia , Traumatismos Faciais/epidemiologia , Traumatismos Faciais/fisiopatologia , Feminino , Saúde Global , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Exposição Ocupacional/prevenção & controle , Saúde do Trabalhador , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Medição de Risco
15.
Medicine (Baltimore) ; 99(35): e21810, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871902

RESUMO

RATIONALE: The clinical manifestations of the SARS-CoV-2 infection are mainly respiratory but the virus can cause a variety of symptoms. Dermatological findings are less well-characterized. Data is scarce on their timing, type and correlation with the immune response. PATIENT CONCERNS: We present the case of SARS-CoV-2 infection in a previously healthy woman who presented with respiratory symptoms and developed anosmia, diarrhea, and an erythematous maculo-papular rash on day 15 from symptom onset. DIAGNOSIS: The nasopharyngeal swab tested by real time PCR for COVID-19 was positive. We interpreted this as a viral exanthema likely caused by an immune response to SARS-CoV-2 nucleotides. INTERVENTIONS: She was treated with Hydroxychloroquine, Azithromycin and Lopinavir/Ritonavir, and the rash with topical corticosteroids. OUTCOMES: All symptoms resolved except for anosmia which persisted for 6 weeks. At the 4- and 6-weeks follow-up the IgG titers for SARS-CoV-2 were high. LESSONS: We must consider that SARS-CoV-2 has a multi-organ tropism. In our case, the SARS-CoV-2 infection had lung, nasopharyngeal, neurological, digestive, and skin manifestations. Identifying the different manifestations is useful for understanding the extent of SARS-CoV-2 infection. We not only present a rare manifestation but also suggest that cutaneous manifestations may correlate with immunity.


Assuntos
Azitromicina/administração & dosagem , Betacoronavirus , Infecções por Coronavirus , Exantema , Glucocorticoides/administração & dosagem , Hidroxicloroquina/administração & dosagem , Lopinavir/administração & dosagem , Pandemias , Pneumonia Viral , Ritonavir/administração & dosagem , Administração Tópica , Adulto , Antivirais/administração & dosagem , Betacoronavirus/imunologia , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Combinação de Medicamentos , Exantema/diagnóstico , Exantema/tratamento farmacológico , Exantema/etiologia , Exantema/imunologia , Feminino , Humanos , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Avaliação de Sintomas/métodos , Resultado do Tratamento
16.
Am J Case Rep ; 21: e925813, 2020 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-32814757

RESUMO

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic that spread from China is caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). The head and neck region can be variably affected in adult patients, and taste and smell disorders are typical manifestations. However, pediatric clinical signs are less severe, making the onset diagnosis challenging to interpret. The variability of nasal olfactory symptoms in children and adolescents is intertwined with possible warning signs, including gastrointestinal, ocular, or dermatological symptoms. We present a case involving a 15-year-old boy with clinically confirmed COVID-19 who had late-onset rash and transient taste and smell disorders. CASE REPORT The boy's clinical history revealed that a family member was positive for SARS-CoV-2. In the preceding 3 days, the boy's eating habits had changed; he perceived a metallic taste while eating and had a loss of appetite. He also had erythematous skin lesions on the lower limbs for the 2 previous days. A sore throat, nasal congestion, and a runny nose were reported on head and neck examination. A real-time polymerase chain reaction test was positive, confirming the initial diagnostic hypothesis. CONCLUSIONS SARS-CoV-2 virus infection in children and adolescents can be asymptomatic, but it can also occur with fever, dry cough, fatigue, and gastrointestinal symptoms. Due to the unique immune characteristics of pediatric and adolescent patients, the correct interpretation of the gustatory and skin symptoms associated with specific laboratory tests for SARS-CoV-2 infection can lead to the most appropriate management and supportive care.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Disgeusia/etiologia , Exantema/etiologia , Transtornos do Olfato/etiologia , Pneumonia Viral/complicações , Olfato/fisiologia , Paladar/fisiologia , Adolescente , Infecções por Coronavirus/epidemiologia , Disgeusia/fisiopatologia , Exantema/diagnóstico , Humanos , Masculino , Transtornos do Olfato/fisiopatologia , Pandemias , Pneumonia Viral/epidemiologia
20.
PLoS One ; 15(7): e0234818, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32663210

RESUMO

BACKGROUND: Erlotinib is an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors used to treat EGFR mutation positive non-small-cell lung cancer (NSCLC). Skin rash and diarrhea are well-known and common adverse events in patients receiving erlotinib, whereas other adverse events, including eye, liver, or renal disorders have not been evaluated adequately. This meta-analysis aimed to evaluate the ocular, hepatobiliary, and renal toxicities of erlotinib in patients with NSCLC cancers. METHODS: In total, sixty studies were assessed, and the results of the included studies were quantitatively integrated using meta-analysis. The incidence of ocular, hepatobiliary (alanine aminotransferase [ALT] and bilirubin elevations; other hepatic adverse events), and renal adverse events were estimated. Additionally, the erlotinib-treated groups and the control groups (placebo or other treatment) were compared with respect to ocular disorders and ALT elevation. The study protocol has been registered in the International Prospective Register for Systematic Reviews (PROSPERO) CRD42018093758. RESULTS: The overall incidence of ocular disorders was 3.30% (95% confidence interval [CI] 2.20%-5.00%). The incidence of ALT elevation, bilirubin elevation, and other hepatobiliary disorders was 6.40% (95% CI 3.90%-10.4%), 3.80% (95% CI 2.30%-6.10%), and 1.00% (95% 0.60%-1.80%), respectively. The incidence of renal disorder was 3.10% (95% CI 1.90%-5.00%). The risk of ocular toxicity in the erlotinib treatment group was significantly increased (risk ratio = 2.91; 95% CI 1.70-4.98) compared to that in the control group. ALT elevation was not significantly different between the two groups. CONCLUSION: Based on the results, careful monitoring of ocular toxicity in patients receiving erlotinib should be recommended and closer monitoring of hepatic toxicity should be also recommended in patients with liver-related risk factors.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/fisiopatologia , Cloridrato de Erlotinib/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doenças do Sistema Digestório/etiologia , Intervalo Livre de Doença , Receptores ErbB/genética , Cloridrato de Erlotinib/uso terapêutico , Exantema/etiologia , Olho/efeitos dos fármacos , Oftalmopatias/etiologia , Feminino , Trato Gastrointestinal/efeitos dos fármacos , Humanos , Rim/efeitos dos fármacos , Nefropatias/etiologia , Neoplasias Pulmonares/genética , Masculino , Mutação , Inibidores de Proteínas Quinases/uso terapêutico
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