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2.
Pan Afr Med J ; 33: 19, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31312335

RESUMO

Varicella is a viral disease whose cause is poorly known in Burkina Faso. The aim of this study is to describe varicella features in the department of infectious diseases at the Yalgado Ouedraogo University Hospital. We here report a series of 19 cases of patients hospitalized between the 1stJanuary 2005 and 31st December 2014. The study included all patients with complete and workable medical records who received a positive diagnosis of varicella. The rate of varicella was 6.2%, accounting for 14.6% of febrile rash. It had been more common in 2011, from January to March. The average age was 19 years and half of the patients were aged between 6 and 30 years. Comorbidities were dominated by HIV infection and herpes. Clinically, fever and pruritus were the typical symptoms and vesicles were the most common type of eruption. On admission, the main complications included pulmonary, hematological and cutaneous complications. The median duration of hospitalization was 5 days, ranging between 0 and 13 days. The main treatments were based on antiviral drugs in 9 cases, antipyretic drugs in 19 cases, topic drugs in 17 cases and antihistamines in 11 cases. Out of 19 cases of varicella, 14 were cured and 2 died, including 1 adult out of 10 and 1 child out of 9. Varicella is usually a benign disease. It can be fatal in adults and children with severe complications.


Assuntos
Varicela/epidemiologia , Infecções por HIV/epidemiologia , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Burkina Faso , Varicela/complicações , Varicela/mortalidade , Criança , Feminino , Febre/epidemiologia , Febre/etiologia , Hospitais Universitários , Humanos , Tempo de Internação , Masculino , Prurido/epidemiologia , Prurido/etiologia , Adulto Jovem
3.
BMJ Case Rep ; 12(4)2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30948409

RESUMO

Varicella gangrenosum is a gangrenous ulceration of varicella lesions involving the skin and soft tissues of the body. The term was coined more than 100 years ago. This occurs due to superimposed bacterial infection. The presentation of primary varicella in adults is more severe with catastrophic systemic complications as compared with children. These complications include necrotising fasciitis, disseminated intravascular coagulation, wet/dry gangrene and death, as was seen in our case. Survival is dependent on early diagnosis and treatment. Adequate antibiotic treatment and particularly early radical surgical debridement should be the cornerstone of management. Less than 10 such cases are reported in the literature.


Assuntos
Varicela/complicações , Fasciite Necrosante/etiologia , Gangrena/etiologia , Infecções Estafilocócicas/complicações , Fasciite Necrosante/diagnóstico , Evolução Fatal , Gangrena/diagnóstico , Doenças dos Genitais Masculinos/etiologia , Herpesvirus Humano 3/isolamento & purificação , Humanos , Extremidade Inferior/patologia , Masculino , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Adulto Jovem
6.
BMJ Case Rep ; 11(1)2018 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-30567124

RESUMO

A 2-month-old girl with normal development and no previous physical illnesses was resuscitated having been found lifeless on her back at home. On admission to Paediatric Intensive Care, she had severe metabolic disturbance, associated with an extremely troubling neurological signs. She died 2 hours later. A full body CT scan did not reveal injury and her parents declined an autopsy. Peripheral blood and cerebrospinal fluid samples were sterile. However, a broad-range PCR coupled with electrospray-ionisation mass spectrometry onto the PLEX-ID automat of peripheral blood revealed the presence of varicella zoster virus. There was a specific viral load in whole blood of 20 542 copies/ml. It is presumed that Varicella myocarditis was the likely cause of death. Our case illustrates the potential usefulness of a broad range PCR strategy in determining infectious causes of death in sudden infant death. Varicella is a potential cause of sudden infant death.


Assuntos
Herpesvirus Humano 3/genética , Miocardite/complicações , Reação em Cadeia da Polimerase/instrumentação , Morte Súbita do Lactente/genética , Causas de Morte , Varicela/complicações , Evolução Fatal , Feminino , Herpesvirus Humano 3/isolamento & purificação , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Miocardite/virologia , Morte Súbita do Lactente/diagnóstico , Morte Súbita do Lactente/etiologia , Carga Viral
7.
BMJ Case Rep ; 11(1)2018 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-30567136

RESUMO

A 36-year-old woman presented with diminution of vision and floaters in both the eyes. Both eyes had disc oedema, multiple pockets of neurosensory detachments along with vitritis. Fluorescein angiography and optical coherence tomography showed characteristic features of Vogt-Koyanagi-Harada (VKH) syndrome (figure 1). She was started on corticosteroid pulse therapy and immunosuppressants following which her VKH lesions resolved. However, she developed chickenpox after 2 weeks and after 1 month she developed discrete yellowish white retinitis patches in the periphery of the right eye which were consistent with a diagnosis of acute retinal necrosis. She was started on oral antivirals for the same and immunosuppressants were withheld in view of immunocompromised state potentially acting as a trigger for reactivation of latent virus. Retinitis patches started to resolve and showed a favourable response to the treatment.


Assuntos
Varicela/complicações , Imunossupressores/efeitos adversos , Síndrome de Necrose Retiniana Aguda/induzido quimicamente , Síndrome Uveomeningoencefálica/complicações , Adulto , Antivirais/administração & dosagem , Antivirais/uso terapêutico , Varicela/tratamento farmacológico , Varicela/virologia , Diagnóstico Diferencial , Feminino , Angiofluoresceinografia/métodos , Herpesvirus Humano 3/isolamento & purificação , Humanos , Imunossupressores/uso terapêutico , Síndrome de Necrose Retiniana Aguda/diagnóstico , Síndrome de Necrose Retiniana Aguda/tratamento farmacológico , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento , Síndrome Uveomeningoencefálica/diagnóstico por imagem , Síndrome Uveomeningoencefálica/tratamento farmacológico
8.
BMJ Case Rep ; 20182018 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-29930190

RESUMO

Necrotising fasciitis (NF) is an infrequent yet significant complication of primary varicella infection in immunocompetent children. We report a case of a 4-year-old girl who presented three days into her chicken pox illness, with a rapidly progressing, severely tender erythematous rash surrounding one chicken pox lesion on her thigh. She required intravenous antibiotics, two surgical debridements, a skin graft and a prolonged stay in the paediatric intensive care unit, but ultimately we were able to save her life and limb. NF is a rare complication of chicken pox that has high morbidity and mortality that requires prompt and specific treatment.


Assuntos
Antibacterianos/administração & dosagem , Varicela/complicações , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/terapia , Administração Intravenosa , Antibacterianos/uso terapêutico , Pré-Escolar , Desbridamento , Fasciite Necrosante/etiologia , Feminino , Humanos , Imunocompetência , Unidades de Terapia Intensiva Pediátrica , Transplante de Pele , Resultado do Tratamento
10.
BMJ Case Rep ; 20182018 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-29622711

RESUMO

A 4-year-old girl presented with acute left visual loss 4 weeks after uneventful chickenpox. She was found to have left necrotising retinitis and profound retinal vasculitis and vitritis. Aqueous humour was PCR positive for varicella-zoster virus. Combined intravenous and intravitreal antiviral treatment led to rapid improvement with settled retinitis, no vascular occlusion and good recovery of vision. Her recent coinfection with Epstein-Barr virus may have acted to provoke the retinitis.


Assuntos
Varicela/complicações , Herpes Zoster Oftálmico/diagnóstico , Pan-Uveíte/diagnóstico , Síndrome de Necrose Retiniana Aguda/diagnóstico , Vasculite Retiniana/diagnóstico , Transtornos da Visão/virologia , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Humor Aquoso/virologia , Pré-Escolar , Feminino , Herpes Zoster Oftálmico/tratamento farmacológico , Herpes Zoster Oftálmico/fisiopatologia , Humanos , Pan-Uveíte/tratamento farmacológico , Pan-Uveíte/fisiopatologia , Pan-Uveíte/virologia , Síndrome de Necrose Retiniana Aguda/tratamento farmacológico , Síndrome de Necrose Retiniana Aguda/fisiopatologia , Síndrome de Necrose Retiniana Aguda/virologia , Vasculite Retiniana/tratamento farmacológico , Vasculite Retiniana/fisiopatologia , Vasculite Retiniana/virologia , Resultado do Tratamento , Transtornos da Visão/diagnóstico por imagem , Transtornos da Visão/tratamento farmacológico
11.
BMC Infect Dis ; 18(1): 118, 2018 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-29514602

RESUMO

BACKGROUND: End stage renal disease (ESRD)/ end stage renal failure (ESRF) is on the rise globally and especially in Singapore. Varicella or chickenpox is not uncommon among adults especially ESRD/ESRF patients. It has been reported to cause complications and even death among immunocompetent adults. METHODS: A retrospective data collection on patients with varicella infection and ESRD in Singapore General Hospital (SGH) from the year 2005 to 2016 was performed. Continuous data and categorical data were summarized as median (range) and count (%) respectively. The association of health care utilization (total length of hospital stay, readmission related to varicella, intensive care unit admission) and mortality with complication due to varicella were tested using chi-square and Mann-Whitney test for categorical and continuous outcomes respectively. RESULTS: Sixty-six patients with ESRD developed varicella during the study period (2005-2016). The case incidence rates for varicella among ESRD ranges from 97 to 267 per 100,000 populations with ESRD yearly. There were 9 deaths (13.6%). Mortality was higher among the ESRD patients with one or more varicella complications compared to patients without complications ((25% vs 7.1%, 95% CI for difference: - 1.1%, 36.9%, p = .063). Likewise, utilisation of intensive or high dependency units were higher among patients with complications compared to those without (20.8% vs 2.4%, 95% CI for difference: 1.6%, 35.3%, p = .012). Length of stay was twice as long in the group with complications compared to patients without (median (IQR) days: 14 (8, 21) vs 7 (5, 14), p = .065), although it did not reach statistical significance. CONCLUSIONS: Varicella is associated with high morbidity and significant mortality rate in ESRD patients. Varicella vaccination is recommended for seronegative ESRD patients.


Assuntos
Varicela/diagnóstico , Falência Renal Crônica/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Varicela/complicações , Varicela/epidemiologia , Varicela/mortalidade , Feminino , Herpesvirus Humano 3/imunologia , Hospitais Gerais , Humanos , Unidades de Terapia Intensiva , Falência Renal Crônica/complicações , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Singapura/epidemiologia , Taxa de Sobrevida , Adulto Jovem
13.
J Med Econ ; 21(4): 416-424, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29357715

RESUMO

BACKGROUND: In Argentina, varicella vaccination was included in the national schedule for mandatory immunizations in 2015. The vaccine has been shown to substantially reduce the morbidity and mortality associated with the virus. The purpose of this study was to evaluate the clinical and economic burden associated with varicella in Argentina prior to vaccine introduction. METHODS: This was a multi-center, retrospective chart review study among patients aged 1-12 years with a primary varicella diagnosis in 2009-2014 in Argentina. Healthcare resource utilization (HCRU) associated with varicella and its complications, unit costs, and work loss were used to estimate direct and indirect costs. All costs are presented in 2015 United States dollars (USD). RESULTS: One hundred and fifty children with varicella were included (75 outpatients, 75 inpatients), with a mean age of 3.8 (SD = 2.4) and 2.9 (SD = 2.2) years, respectively. One or more complications were experienced by 28.0% of outpatients and 98.7% of inpatients, the most common being skin and soft tissue infections, pneumonia, sepsis, cerebellitis, and febrile seizure. HCRU estimates included use of over-the-counter (OTC) medications (58.7% outpatients, 94.7% inpatients), prescription medications (26.7% outpatients, 77.3% inpatients), tests/procedures (13.3% outpatients, 70.7% inpatients), and consultation with allied health professionals (1.3% outpatients, 32.0% inpatients). The average duration of hospital stay was 4.9 (95% CI = 4.2-5.7) days, and the average duration of ICU stay was 4.8 (95% CI = 1.6-14.1) days. The total combined direct and indirect cost per varicella case was 2947.7 USD (inpatients) and 322.7 USD (outpatients). The overall annual cost of varicella in Argentina for children aged ≤14 years in 2015 was estimated at 40,054,378.0 USD. CONCLUSION: The clinical burden of varicella in Argentina was associated with utilization of significant amounts of healthcare resources, resulting in substantial economic costs. These costs should be reduced with the recent implementation of routine vaccination of children.


Assuntos
Varicela/economia , Varicela/epidemiologia , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Argentina/epidemiologia , Varicela/complicações , Varicela/terapia , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Feminino , Humanos , Lactente , Masculino , Modelos Econométricos , Medicamentos sem Prescrição/economia , Medicamentos sob Prescrição/economia , Estudos Retrospectivos
14.
Int Ophthalmol ; 38(5): 2187-2190, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28825165

RESUMO

PURPOSE: To report a case of presumed autoimmune retinopathy in a patient who had been diagnosed with chickenpox immediately prior to symptom onset. METHOD: This is a retrospective case report with fundus autofluorescence and spectral-domain optical coherence tomography. RESULTS: A 29-year-old immunocompetent man presented with a two-month history of photopsia and a bluish light predominantly in the left eye with onset immediately following a diagnosis of chickenpox. He subsequently developed blurring of vision in his left eye with spectral-domain optical coherence tomography showing disruption and loss of ellipsoid layer in a perivascular pattern in both eyes with fundus autofluorescence demonstrating an abnormal increase in autofluorescence predominately around the vascular arcades. Autoimmune retinopathy was suspected on the basis of the clinical presentation, electrophysiology, absence of fundus lesions, retinal degenerations or dystrophies, or intraocular inflammation and temporal association with varicella infection. Antiretinal antibody testing with Western blot and immunohistochemistry were reported to be negative, however, given the consistent evidence from all other aspects of workup and investigation the patient was commenced on a trial of prednisone. This resulted in marked reduction in photopsia and expansion of visual fields. CONCLUSION: The diagnosis of autoimmune retinopathy is ultimately clinical in nature. Despite the absence of positive retinal autoantibodies, a diagnosis of autoimmune retinopathy was made based upon consistent evidence from all other aspects of workup and investigation. This allowed prompt treatment with immunosuppressive agents with subsequent stabilization of this patient's visual function.


Assuntos
Doenças Autoimunes/etiologia , Varicela/complicações , Retina/patologia , Degeneração Retiniana/etiologia , Acuidade Visual , Adulto , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/fisiopatologia , Eletrorretinografia , Angiofluoresceinografia/métodos , Fundo de Olho , Humanos , Masculino , Degeneração Retiniana/diagnóstico , Degeneração Retiniana/imunologia , Tomografia de Coerência Óptica/métodos , Campos Visuais
16.
Przegl Epidemiol ; 72(4): 459-467, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30809999

RESUMO

OBJECTIVES: The aim of this study was to describe the epidemiology of chickenpox complications in children, based on a 19-year long survey. METHODS: This publication constitutes a review of medical records of 761 patients under the age of 18 who were hospitalized at the T. Browicz Provincial Hospital for Infectious Diseases in Bydgoszcz, Poland from the 1st of January 1999 to the 31st of December 2017. RESULTS: Over the study period, 761 children diagnosed with varicella complications were hospitalized. The mean number of hospitalizations in each year amounted to 40. The median age of admitted patients was 4 years. The median length of hospitalization was 5 days (ranged from 1 to 30 days). The most frequent varicella complications included respiratory tract infections ­ 229/761 (30.1%), bacterial skin infections ­ 189/761 (24.8%) and gastrointestinal tract disorders ­ 142/761 (18.6%). Pneumonia, bronchitis and gastrointestinal tract disturbances, were reported most often in children under 2 years of age, while neurological complications occurred most frequently in children at 3-6 years of age. No significant differences in the number of varicella complications between immunocompromised and immunocompetent children were reported. CONCLUSIONS: Varicella complications mainly affect the youngest immunocompetent children. Population-wide vaccination and herd immunity appears to be the best way to reduce the incidence of chickenpox and the rate of varicella complications. This study gives support for inclusion of universal varicella vaccine in the National Immunization Program in Poland.


Assuntos
Varicela/complicações , Gastroenteropatias/etiologia , Hospitalização/estatística & dados numéricos , Infecções Respiratórias/etiologia , Dermatopatias Bacterianas/etiologia , Varicela/prevenção & controle , Vacina contra Varicela , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Polônia , Estudos Retrospectivos
17.
Pan Afr Med J ; 31: 30, 2018.
Artigo em Francês | MEDLINE | ID: mdl-30918557

RESUMO

Varicella is a rash illness caused by the varicella-zoster virus. It mainly affects children with usually a benign outcome. However, several complications of variable severity can be observed including bacterial infectious complications and neurological complications. We report two cases of complicated varicella. Case 1: 5 month old baby with no previous pathological history presenting with a rash composed of vesicles and pustules lasting for six days. Symptoms worsened the day before his admission to our Department due to respiratory distress. Case 2: 7-Year old girl admitted to our Department due to simple convulsion. Clinical examination showed generalized varicella scars and cerebellar ataxia. Although varicella is a common, in most cases benign viral disease, several studies have recently reported a recrudescence of complications, which appear to be responsible for 0.2-1.5% of the causes of hospitalization in children with varicella.


Assuntos
Ataxia Cerebelar/virologia , Varicela/complicações , Insuficiência Respiratória/virologia , Criança , Feminino , Hospitalização , Humanos , Lactente , Masculino
18.
BMJ Case Rep ; 20172017 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-29275386

RESUMO

A 97-year-old woman presented with 4-day history of vesicular rash, initially at the feet but then spread up to the thighs bilaterally, abdomen and trunk. The initial differentials included bullous pemphigus and cellulitis by the emergency department. She was then managed as bullous pemphigus by the acute medical team and started on high-dose steroids, with no other differentials considered. When her care was taken over by the general medical team, varicella zoster virus (VZV) infection was suspected. After confirmation by the dermatology team regarding the clinical diagnosis and the positive VZV DNA swabs, she was started on acyclovir.


Assuntos
Aciclovir/administração & dosagem , Antivirais/administração & dosagem , Varicela/diagnóstico , Varicela/tratamento farmacológico , Herpesvirus Humano 3/isolamento & purificação , Administração Intravenosa , Idoso de 80 Anos ou mais , Varicela/complicações , Diagnóstico Diferencial , Exantema/etiologia , Evolução Fatal , Feminino , Febre/etiologia , Insuficiência Cardíaca/complicações , Humanos
19.
BMJ Case Rep ; 20172017 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-28882940

RESUMO

We report a 16-month-old girl with varicella complicated by cellulitis, invasive Group A Streptococcus (GAS) infection and deep vein thrombosis. She presented with varicella lesions, fever and a painful firm tumefaction on the right lower leg (RLL). Ultrasound showed a local subcutaneous tissue thickening suggestive of cellulitis and antibiotics were initiated. Further swelling of the RLL motivated a second ultrasound that showed an obstructive thrombus for which she was started on enoxaparin. The blood culture confirmed GAS infection leading to directed antibiotherapy. Additional studies showed positive lupus anticoagulant, decreased protein S and antithrombin. She completed a 2-week course of intravenous antibiotics and anticoagulation therapy with clinical and laboratory markers improvement. However, 3 days later, a recrudescence of symptoms occurred and the ultrasound revealed a local abscess. Further amoxicillin treatment resulted on a complete resolution of symptoms. Doppler ultrasound after 1 month showed markedly increased vein patency.


Assuntos
Celulite (Flegmão)/etiologia , Varicela/complicações , Infecção pelo Vírus da Varicela-Zoster/complicações , Trombose Venosa/etiologia , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Celulite (Flegmão)/diagnóstico por imagem , Celulite (Flegmão)/tratamento farmacológico , Celulite (Flegmão)/patologia , Varicela/virologia , Diagnóstico Diferencial , Enoxaparina/administração & dosagem , Enoxaparina/uso terapêutico , Feminino , Herpesvirus Humano 3/isolamento & purificação , Humanos , Lactente , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus/isolamento & purificação , Resultado do Tratamento , Ultrassonografia Doppler/métodos , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico , Trombose Venosa/patologia
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