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4.
Pediatr Dermatol ; 37(3): 435-436, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32315079

RESUMO

It has been reported that the novel coronavirus disease (COVID-19) may be associated with a papulovesicular skin eruption predominantly involving the trunk. We hereby present a case of COVID-19-associated varicella-like exanthem in an 8-year-old girl with mild systemic symptoms.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/patologia , Exantema/diagnóstico , Exantema/virologia , Pneumonia Viral/complicações , Pneumonia Viral/patologia , Criança , Feminino , Humanos , Pandemias
5.
Medicine (Baltimore) ; 99(1): e18503, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895784

RESUMO

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease. In clinical practice, we have observed that some HLH patients who have features of systemic autoinflammatory diseases (SAIDs) exhibit unique clinical manifestations and outcomes different from other HLH patients.We analyzed data from 25 HLH patients who were considered to have SAIDs; data were collected from patients of our center between January 1, 2015 and September 1, 2018.The median age of the patients was 1.75 years. In the early phase, all patients had a fever and 92% of patients had a rash; 96% of patients had high white blood cell count (WBC), C-reaction protein, and erythrocyte sedimentation rate. With progression, the above laboratory results decreased gradually. During the HLH period, we compared SAIDs-related HLH and Epstein-Barr virus (EBV)-related HLH and found that rash was more common (92%, P < .001) and splenomegaly was less common (64%, P = .023) in SAIDs-related HLH. Further, WBC, ferritin, and Interleukin-6 levels in SAIDs-related HLH patients were higher than those in EBV-related HLH patients. In contrast, hemoglobin, triglyceride, sCD25, Interleukin-10, and interferon-γ levels in SAIDs-related HLH patients were lower compared with those in EBV-related HLH patients. SAIDs-related HLH patients received a modified HLH-2004 protocol at our center. Most patients had a good prognosis.We provide a summary of the unique clinical and laboratory features, treatment protocols, and outcomes of SAIDs patients with HLH at onset. The findings indicate that these patients had a better response to corticosteroids and cyclosporin compared with EBV-related HLH patients.


Assuntos
Doenças Autoimunes/patologia , Infecções por Vírus Epstein-Barr/patologia , Exantema/etiologia , Herpesvirus Humano 4 , Linfo-Histiocitose Hemofagocítica/patologia , Corticosteroides/uso terapêutico , Doenças Autoimunes/imunologia , Doenças Autoimunes/virologia , Sedimentação Sanguínea , Proteína C-Reativa , Ciclosporina/uso terapêutico , Infecções por Vírus Epstein-Barr/imunologia , Infecções por Vírus Epstein-Barr/virologia , Exantema/patologia , Exantema/virologia , Feminino , Humanos , Lactente , Contagem de Leucócitos , Linfo-Histiocitose Hemofagocítica/imunologia , Linfo-Histiocitose Hemofagocítica/virologia , Masculino , Esplenomegalia/imunologia , Esplenomegalia/virologia , Resultado do Tratamento
6.
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
11.
Am J Trop Med Hyg ; 101(6): 1219-1225, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31595869

RESUMO

Fifty-two febrile patients living in Barquisimeto, Venezuela, were screened for arbovirus infection by virus culture during an outbreak of what was thought to be Zika virus infection. We report identification of Mayaro virus (MAYV) on culture of plasma from one patient, an 18-year-old woman with acute febrile illness, arthralgias, and psoriasiform rash. The strain was sequenced and was found to be most closely related to a 1999 strain from French Guiana, which, in turn, was related to two 2014 strains from Haiti. By contrast, previously reported outbreak-related MAYV strains from a sylvatic area approximately 80 miles from where the case patient lived were most closely related to Peruvian isolates. The two strain groups show evidence of having diverged genetically approximately 100 years ago.


Assuntos
Infecções por Alphavirus/diagnóstico , Alphavirus/isolamento & purificação , Artralgia/virologia , Exantema/virologia , Febre/virologia , Doença Aguda , Adolescente , Alphavirus/genética , Infecções por Alphavirus/virologia , Surtos de Doenças , Doenças Endêmicas , Feminino , Humanos , Filogenia , Análise de Sequência de DNA , Venezuela
12.
Pediatr Dermatol ; 36(6): 929-931, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31576583

RESUMO

We present two pediatric cases of recurrent mucositis associated with influenza B infection, both in patients with prior episodes of Stevens-Johnson syndrome (SJS) due to Mycoplasma. Influenza B is an uncommon cause of both rash and mucosistis and SJS.


Assuntos
Exantema/virologia , Influenza Humana/diagnóstico , Mucosite/virologia , Pneumonia por Mycoplasma/diagnóstico , Síndrome de Stevens-Johnson/etiologia , Adolescente , Conjuntivite Viral/virologia , Feminino , Humanos , Imunoglobulina M/sangue , Vírus da Influenza B/isolamento & purificação , Masculino , Mycoplasma pneumoniae/imunologia
13.
Gastroenterology ; 157(4): e8-e9, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31476298
14.
Pediatrics ; 144(3)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31471448

RESUMO

CONTEXT: Live vaccines usually provide robust immunity but can transmit the vaccine virus. OBJECTIVE: To assess the characteristics of secondary transmission of the vaccine-strain varicella-zoster virus (Oka strain; vOka) on the basis of the published experience with use of live varicella and zoster vaccines. DATA SOURCES: Systematic review of Medline, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Scopus databases for articles published through 2018. STUDY SELECTION: Articles that reported original data on vOka transmission from persons who received vaccines containing the live attenuated varicella-zoster virus. DATA EXTRACTION: We abstracted data to describe vOka transmission by index patient's immune status, type (varicella or herpes zoster) and severity of illness, and whether transmission was laboratory confirmed. RESULTS: Twenty articles were included. We identified 13 patients with vOka varicella after transmission from 11 immunocompetent varicella vaccine recipients. In all instances, the vaccine recipient had a rash: 6 varicella-like and 5 herpes zoster. Transmission occurred mostly to household contacts. One additional case was not considered direct transmission from a vaccine recipient, but the mechanism was uncertain. Transmission from vaccinated immunocompromised children also occurred only if the vaccine recipient developed a rash postvaccination. Secondary cases of varicella caused by vOka were mild. LIMITATIONS: It is likely that other vOka transmission cases remain unpublished. CONCLUSIONS: Healthy, vaccinated persons have minimal risk for transmitting vOka to contacts and only if a rash is present. Our findings support the existing recommendations for routine varicella vaccination and the guidance that persons with vaccine-related rash avoid contact with susceptible persons at high risk for severe varicella complications.


Assuntos
Vacina contra Varicela/imunologia , Vacina contra Herpes Zoster/imunologia , Infecção pelo Vírus da Varicela-Zoster/transmissão , Vacina contra Varicela/efeitos adversos , Exantema/virologia , Vacina contra Herpes Zoster/efeitos adversos , Humanos , Imunocompetência , Hospedeiro Imunocomprometido , Fatores de Risco , Soroconversão , Índice de Gravidade de Doença , Vacinas Atenuadas
15.
Medicine (Baltimore) ; 98(33): e16493, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415349

RESUMO

RATIONALE: Unlike other enteroviruses which can cause herpangina or hand-foot-and-mouth disease, enterovirus D68 (EV-D68) has usually been linked to respiratory and neurological problems in young children. Skin manifestations had rarely been described in current literatures. PATIENT CONCERNS: We report a 17-year-old girl with fever and painful skin rash over legs and soles for 9 days. Pitting edema was also noted below the knees. There was no respiratory tract or neurological symptoms in this patient. DIAGNOSES: EV-D68 was detected from a throat swab by RT-PCR and confirmed to be subclade B3 by sequencing. INTERVENTIONS: Supportive management. OUTCOMES: The patient was afebrile after 9 days and got full recovery on the 23rd day at outpatient follow-up. LESSONS: To the best of our knowledge, this is the first report of EV-D68 infection with skin manifestations, clinical images, and detailed clinical course. Our findings in this particular case extend the understanding of the disease spectrum.


Assuntos
Dor Aguda/virologia , Enterovirus Humano D , Infecções por Enterovirus/virologia , Exantema/virologia , Dor Aguda/patologia , Adolescente , Infecções por Enterovirus/patologia , Exantema/patologia , Feminino , Humanos
16.
Pediatr Infect Dis J ; 38(9): e223-e225, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31408057

RESUMO

We describe the first 2 cases from the United States, of human parechovirus infection in infants manifesting a distinct rash of the hands and feet. We propose the term "Mittens and Booties Syndrome" and provide a review of the literature of all published cases.


Assuntos
Exantema/virologia , Pé/patologia , Mãos/patologia , Infecções por Picornaviridae/complicações , Infecções por Picornaviridae/diagnóstico , Edema/virologia , Eritema/virologia , Pé/virologia , Mãos/virologia , Humanos , Lactente , Masculino , Parechovirus/patogenicidade , Infecções por Picornaviridae/virologia , Estados Unidos
17.
Ann Glob Health ; 85(1)2019 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-31468955

RESUMO

BACKGROUND: Brazil presented an alarming number of newborns with microcephaly in the years 2015 and 2016. The investigation of the cases raised the suspicion of the association of these cases with maternal infections by the zika virus. Also, in 2015, there was an epidemic of zika virus infection in Brazil, reinforcing this hypothesis. OBJECTIVE: The objective of this study was to identify factors associated with the diagnosis of microcephaly in newborns, including zika virus infection. METHODS: We conducted a case-control study. The cases were defined as children who received clinical and imaging diagnosis of microcephaly, born after October 2015 in Ceará, Brazil, which recorded the highest number of microcephaly cases in Brazil during the outbreak. The cases were identified in medical records of public and private maternity hospitals and in child development stimulation clinics tracked until June 2017. Epidemiological, clinical, and socioeconomic variables were collected, visiting their homes and confirming data from their medical records. Controls were children without microcephaly identified in the vicinity of the residence of each case. Logistic regression models were used to control confounding. FINDINGS: We evaluated 58 cases and 116 controls. The odds of having a baby with microcephaly was 14 times higher among mothers who had zika virus infection (p < 0.001), after multivariate analysis. Arboviruses infections symptoms, as fever (p = 0.220), skin change (p < 0.001), and joint pain (p = 0.002) also demonstrated an association with microcephaly. CONCLUSIONS: Maternal infection zika virus was associated with a diagnosis of microcephaly. Our study contributes to the investigation of the epidemiological factors associated with the diagnosis of microcephaly.


Assuntos
Microcefalia/epidemiologia , Infecção por Zika virus/epidemiologia , Artralgia/epidemiologia , Artralgia/virologia , Brasil/epidemiologia , Estudos de Casos e Controles , Exantema/epidemiologia , Exantema/virologia , Feminino , Febre/epidemiologia , Febre/virologia , Humanos , Lactente , Masculino , Microcefalia/diagnóstico por imagem , Microcefalia/virologia , Infecção por Zika virus/complicações
18.
Clin Dermatol ; 37(3): 213-226, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31178104

RESUMO

Viral exanthems are frequent in children and are mostly self-limited. Early recognition and differentiation from other childhood illnesses are important to direct further investigations and treatment initiation. The clinical presentation of viral exanthems in children includes a polymorphic spectrum of skin eruptions ranging from classic viral exanthems to "atypical" presentations that can mimic nonviral diseases; thus, viral exanthems of childhood can be readily diagnosed on clinical grounds, but not rarely do they represent a diagnostic challenge. In this review, we focus on viral diseases in children that may be difficult to diagnose due to their clinical similarities with nonviral diseases, and we offer clues for the differential diagnosis and proper diagnostic testing in such cases.


Assuntos
Exantema/diagnóstico , Exantema/virologia , Pele/virologia , Acrodermatite , Angiomatose , Febre de Chikungunya , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Dengue , Diagnóstico Diferencial , Exantema/patologia , Feminino , Doença de Mão, Pé e Boca , Herpesvirus Humano 4 , Humanos , Hospedeiro Imunocomprometido , Lactente , Masculino , Testes Sorológicos , Pele/patologia , Zika virus
19.
PLoS One ; 14(5): e0217415, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150445

RESUMO

INTRODUCTION AND METHODS: Hepatitis B is a vaccine preventable disease and is notifiable in South Africa. Hepatitis B vaccination was incorporated into the Expanded Programme on Immunisation in South Africa in 1995. We used a convenience sample from community-based febrile rash surveillance in 2013 to estimate hepatitis B sero-prevalence. Of samples serologically negative for acute measles infection, 450 samples spanning nine provinces of South Africa were tested for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs) and hepatitis B core antibody (anti-HBc). RESULTS: Two children (2/450; 0.4%) tested positive for HBsAg. Three hundred and three children (67.3%) had evidence of vaccine induced immunity. Vaccine induced immunity was present in 80.2% of 1-5 year olds, but only 60.3% of 10-14 year olds. Natural immunity, indicating exposure to circulating hepatitis B, was present in 13/450 (2.9%) children. CONCLUSION: Chronic hepatitis B in South African has decreased in prevalence from highly endemic levels prior to vaccine introduction to approximately 0.4% in this sample, demonstrating impact of a successful vaccination programme 18 years after introduction. Decreased vaccine-induced immunity with increasing age may reflect waning antibody titres over time.


Assuntos
Exantema/virologia , Vacinas contra Hepatite B/imunologia , Hepatite B/epidemiologia , Hepatite B/imunologia , Adolescente , Criança , Pré-Escolar , Feminino , Anticorpos Anti-Hepatite B/imunologia , Antígenos do Núcleo do Vírus da Hepatite B/imunologia , Antígenos de Superfície da Hepatite B/imunologia , Humanos , Programas de Imunização/métodos , Lactente , Recém-Nascido , Masculino , Sarampo/virologia , Prevalência , África do Sul/epidemiologia , Vacinação/métodos
20.
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
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