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1.
BMJ Case Rep ; 14(3)2021 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-33766974

RESUMO

A 54-year-old woman presented with pruritic rash and hives of 3 days' duration followed by shortness of breath for 1 day. SARS-CoV-2 PCR test for COVID-19 was positive. Cutaneous manifestations of COVID-19 include acral lesions, urticarial rash, erythematous maculopapular rash, vascular rashes and vesicular rash. The cutaneous manifestations are mostly described as self-limiting. Urticarial rashes are not reported as the initial presentation symptom of COVID-19 infection but mostly noted to occur at the same time or after the onset of non-cutaneous symptoms. Management of cutaneous manifestations of COVID-19 affecting quality of life has not been well studied. Antihistamine therapy is the primary recommended therapy. Role of antiviral therapy for severe cases of rash needs to be further assessed.


Assuntos
/complicações , Exantema/virologia , Urticária/virologia , Antivirais/uso terapêutico , Fibrilação Atrial/complicações , Exantema/patologia , Exantema/terapia , Feminino , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Hipertensão Pulmonar/complicações , Pessoa de Meia-Idade , Obesidade/complicações , Insuficiência Renal Crônica/complicações , Pele/patologia , Apneia Obstrutiva do Sono/complicações , Resultado do Tratamento , Urticária/patologia , Urticária/terapia
7.
Rev Med Virol ; 30(5): e2130, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32656939

RESUMO

The SARS-Cov-2 is a single-stranded RNA virus composed of 16 non-structural proteins (NSP 1-16) with specific roles in the replication of coronaviruses. NSP3 has the property to block host innate immune response and to promote cytokine expression. NSP5 can inhibit interferon (IFN) signalling and NSP16 prevents MAD5 recognition, depressing the innate immunity. Dendritic cells, monocytes, and macrophages are the first cell lineage against viruses' infections. The IFN type I is the danger signal for the human body during this clinical setting. Protective immune responses to viral infection are initiated by innate immune sensors that survey extracellular and intracellular space for foreign nucleic acids. In Covid-19 the pathogenesis is not yet fully understood, but viral and host factors seem to play a key role. Important points in severe Covid-19 are characterized by an upregulated innate immune response, hypercoagulopathy state, pulmonary tissue damage, neurological and/or gastrointestinal tract involvement, and fatal outcome in severe cases of macrophage activation syndrome, which produce a 'cytokine storm'. These systemic conditions share polymorphous cutaneous lesions where innate immune system is involved in the histopathological findings with acute respiratory distress syndrome, hypercoagulability, hyperferritinemia, increased serum levels of D-dimer, lactic dehydrogenase, reactive-C-protein and serum A amyloid. It is described that several polymorphous cutaneous lesions similar to erythema pernio, urticarial rashes, diffuse or disseminated erythema, livedo racemosa, blue toe syndrome, retiform purpura, vesicles lesions, and purpuric exanthema or exanthema with clinical aspects of symmetrical drug-related intertriginous and flexural exanthema. This review describes the complexity of Covid-19, its pathophysiological and clinical aspects.


Assuntos
Infecções por Coronavirus/imunologia , Síndrome da Liberação de Citocina/imunologia , Coagulação Intravascular Disseminada/imunologia , Eritema/imunologia , Exantema/imunologia , Interações Hospedeiro-Patógeno/imunologia , Pneumonia Viral/imunologia , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Síndrome da Liberação de Citocina/patologia , Síndrome da Liberação de Citocina/virologia , Progressão da Doença , Coagulação Intravascular Disseminada/patologia , Coagulação Intravascular Disseminada/virologia , Eritema/patologia , Eritema/virologia , Exantema/patologia , Exantema/virologia , Regulação da Expressão Gênica , Interações Hospedeiro-Patógeno/genética , Humanos , Imunidade Inata , Linfócitos/imunologia , Linfócitos/patologia , Linfócitos/virologia , Macrófagos/imunologia , Macrófagos/patologia , Macrófagos/virologia , Pandemias , Peptidil Dipeptidase A/genética , Peptidil Dipeptidase A/imunologia , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Receptores Virais/genética , Receptores Virais/imunologia , Serina Endopeptidases/genética , Serina Endopeptidases/imunologia , Índice de Gravidade de Doença , Glicoproteína da Espícula de Coronavírus/genética , Glicoproteína da Espícula de Coronavírus/imunologia
8.
Dermatol Online J ; 26(5)2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32621705

RESUMO

Asymmetric periflexural exanthem of childhood (APEC) is a self-limited disease characterized by unilateral exanthem. The etiology is unknown, but a viral agent is suspected. Most often there is no formal proof of an associated viral etiology, but several associations between APEC and some viruses have been described. We report a 2-year-old girl with APEC associated with influenza A. This case allows us to provide an additional argument on a probable viral etiology of APEC and a possible etiologic role of influenza A.


Assuntos
Exantema/virologia , Vírus da Influenza A/isolamento & purificação , Influenza Humana/complicações , Pré-Escolar , Exantema/patologia , Extremidades/patologia , Feminino , Humanos
10.
Pediatr Dermatol ; 37(5): 966-967, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32524630

RESUMO

Cutaneous manifestations are becoming increasingly well-documented in adults with COVID-19. There is now also a growing body of literature regarding skin involvement in children, with reports of papulovesicular, petechial and widespread macular and papular lesions, and chilblains (pernio). We describe the case of a 13-year-old boy with confirmed COVID-19 in the United Kingdom who presented with skin findings localized to the plantar aspects of the feet, axillae, and lower limbs. The morphology was predominantly maculopapular but also included petechiae and annular lesions.


Assuntos
Doenças Transmissíveis Emergentes/diagnóstico , Infecções por Coronavirus/diagnóstico , Surtos de Doenças/estatística & dados numéricos , Exantema/diagnóstico , Pneumonia Viral/diagnóstico , Síndrome Respiratória Aguda Grave/diagnóstico , Adolescente , Biópsia por Agulha , Diagnóstico Diferencial , Exantema/patologia , Humanos , Imuno-Histoquímica , Masculino , Pandemias , Medição de Risco , Índice de Gravidade de Doença , Reino Unido
14.
Support Care Cancer ; 28(9): 3991-3993, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32514616

RESUMO

Stringent measures have been taken to contain COVID-19 spread, limiting access only for urgent visits, surgery procedures, or hospitalizations and using teledermatology services for non-urgent cases. Management of oncological patients affected by chemo-, immune-, and radiotherapy-related cutaneous and mucosal adverse events is a challenge. Firstly because of the differential diagnosis of cutaneous rash (e.g., drug-related rash or paraviral exanthema). Secondly, oncological patients can suffer from xerosis, pruritus, and mucositis that contribute to cutaneous and mucosal barrier lesions, thus becoming vulnerable site for viral or bacterial colonization. These lesions can also be aggravated by the use of protective mask and gloves. Here, we report also our results of a teledermatological survey on 87 oncological patients, where the health status of oncological patients referred to our dedicated clinic was assessed during the COVID-19 pandemic. Therefore, it is fundamental that oncological patients are followed up by their dermatologists even if the clinics are closed. Teledermatology represents a crucial means of communication. Patients can contact the dermatological staff by emails and telephone, 24 h a day, 7 days a week, for video calls and dermatological consultations.


Assuntos
Infecções por Coronavirus/prevenção & controle , Membrana Mucosa/patologia , Neoplasias/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pele/patologia , Administração Cutânea , Betacoronavirus , Erupção por Droga/diagnóstico , Exantema/patologia , Exantema/virologia , Humanos , Itália , Masculino , Prurido/patologia , Prurido/virologia , Inquéritos e Questionários , Telemedicina/métodos
17.
Nat Microbiol ; 5(7): 955-965, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32341480

RESUMO

Monkeypox is a viral zoonotic disease on the rise across endemic habitats. Despite the growing importance of monkeypox virus, our knowledge on its host spectrum and sylvatic maintenance is limited. Here, we describe the recent repeated emergence of monkeypox virus in a wild, human-habituated western chimpanzee (Pan troglodytes verus, hereafter chimpanzee) population from Taï National Park, Ivory Coast. Through daily monitoring, we show that further to causing its typical exanthematous syndrome, monkeypox can present itself as a severe respiratory disease without a diffuse rash. By analysing 949 non-invasively collected samples, we identify the circulation of at least two distinct monkeypox virus lineages and document the shedding of infectious particles in faeces and flies, suggesting that they could mediate indirect transmission. We also show that the carnivorous component of the Taï chimpanzees' diet, mainly consisting of the sympatric monkeys they regularly hunt, did not change nor shift towards rodent consumption (the presumed reservoir) before the outbreaks, suggesting that the sudden emergence of monkeypox virus in this population is probably due to changes in the ecology of the virus itself. Using long-term mortality surveillance data from Taï National Park, we provide evidence of little to no prior viral activity over at least two decades. We conclude that great ape sentinel systems devoted to the longitudinal collection of behavioural and health data can help clarify the epidemiology and clinical presentation of zoonotic pathogens.


Assuntos
Animais Selvagens , Vírus da Varíola dos Macacos/fisiologia , Monkeypox/virologia , Pan troglodytes/virologia , Animais , Ecossistema , Exantema/etiologia , Exantema/metabolismo , Exantema/patologia , Espaço Extracelular/metabolismo , Fezes/virologia , Genoma Viral , Genômica/métodos , Glutationa/metabolismo , Sequenciamento de Nucleotídeos em Larga Escala , Monkeypox/complicações , Monkeypox/metabolismo , Monkeypox/mortalidade , Vírus da Varíola dos Macacos/classificação , Vírus da Varíola dos Macacos/isolamento & purificação , Pan troglodytes/metabolismo , Filogenia , Transtornos Respiratórios/etiologia , Transtornos Respiratórios/metabolismo
18.
BMJ Case Rep ; 13(4)2020 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-32332045

RESUMO

An 80-year-old woman presented with a several-year history of progressive hair loss and scalp pruritus. No other rashes or muscle weakness were noted on examination. Scalp biopsy showed interface dermatitis, dense perivascular and periadnexal lymphocytic infiltrate, mucin and scarring alopecia. Laboratory analysis did not show evidence of myositis. The patient was started on hydroxychloroquine for possible cutaneous lupus erythematosus. On follow-up, she presented with a new violaceous rash on the superior eyelids and a well-defined oval patch on the mid-hard palate suspicious for dermatomyositis. Myositis-specific autoantibodies revealed presence of anti-transcriptional intermediary factor-1γ (anti-TIF1γ) in the serum. Anti-TIF1γ autoantibody-positive dermatomyositis is a newly recognised subtype of dermatomyositis that is highly associated with amyopathic disease and has an increased risk of malignancy, making prompt diagnosis crucial. This case highlights the utility of a thorough oral exam in patients suspected to have connective tissue disease as the distinctive ovoid palatal patch is nearly pathognomonic for anti-TIF1γ dermatomyositis.


Assuntos
Autoanticorpos/sangue , Dermatomiosite/diagnóstico , Eritema/patologia , Exantema/patologia , Palato Duro/patologia , Idoso de 80 Anos ou mais , Fármacos Dermatológicos/uso terapêutico , Dermatomiosite/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Humanos , Metotrexato/uso terapêutico , Fatores de Transcrição/imunologia
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