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Introducción: La fiebre chikungunya (FCHIK) es una enfermedad febril transmitida por mosquitos, que en el niño tiene manifestaciones clínicas diferentes, dependiendo del grupo de edad. Objetivo: el presente trabajo tiene el propósito de identificar las características clínicas y evolutivas de la FCHIK en pacientes ≤15 años, que acudieron al Instituto de Medicina Tropical (IMT). Materiales y método: estudio observacional, descriptivo retrospectivo, basado en revisión de historias clínicas de pacientes de 0 y 15 años, que consultaron al IMT, entre noviembre/2022 y marzo/ 2023, con diagnóstico de FCHIK. Resultados: de 2050 pacientes febriles que consultaron al IMT entre noviembre/2022 y marzo/2023, 301 fueron casos de FCHIK, 10,6% (32/301) requirió hospitalización, de estos el 62,5% (20/32) era ≤1 año. La presencia de vómitos (p<0.0001.OR= 5,5 IC95% 2.2-13.2), dolor abdominal (p<0.0001.OR=40.5,5 IC95% 4.5-364.3); erupción maculo-papular-ampollar p<0.008. OR=3.5, IC95% 1.3 - 9.1), fue significativamente más frecuente en los hospitalizados. El 37.5% (12/32) fue hospitalizado en UCI y 15,6% (5/32) requirió ARM, 18.7%(6/32) presentó miocarditis; 15.6%(5/32) encefalitis, y 3.1%(1/32) encefalitis y miocarditis. No se registraron óbitos. Conclusiones: La décima parte de los pacientes con FCHIK requirieron hospitalización, de estos más de la mitad fueron <1 año. Las manifestaciones clínicas más frecuentes fueron fiebre, exantema, vómitos, irritabilidad, artralgias, lesiones ampollares. La leucopenia fue significativamente más frecuente en ≤1 año. La edad <3 meses, así como vómitos, exantema vesículo-ampollar, presencia de choque, irritabilidad, convulsiones, dolor abdominal y dificultad respiratoria se asociaron significativamente al requerimiento de hospitalización. Las complicaciones más frecuentes fueron el choque, la miocarditis y la encefalitis.
Introduction: Chikungunya fever (CHKF) is a febrile disease transmitted by mosquitoes, which presentes different clinical manifestations in children, depending on their age group. Objective: to describe the clinical and outcome characteristics of CHKF in patients ≤15 years old, who presented to the Institute of Tropical Medicine (ITM). Materials and methods: this was a retrospective, descriptive and observational study, based on the review of medical records of patients between 0 and 15 years of age, who were evaluated at the ITM, between November/2022 and March/2023, who were diagnosed with CHKF. Results: of 2050 febrile patients who consulted at the ITM between November/2022 and March/2023, 301 were cases of CHKF, 10.6% (32/301) required hospitalization, of which 62.5% (20/32) were ≤ 1 year of age. The presence of vomiting (p<0.0001, OR= 5.5, 95% CI 2.2-13.2), abdominal pain (p<0.0001, OR=40.5.5, 95% CI 4.5-364.3); maculo-papular-bullous rash (p<0.008, OR=3.5, 95% CI 1.3 - 9.1), was significantly more frequent in hospitalized patients. 37.5% (12/32) were hospitalized in the ICU and 15.6% (5/32) required ARM, 18.7% (6/32) presented myocarditis; 15.6%(5/32) encephalitis, and 3.1%(1/32) had both encephalitis and myocarditis. No deaths were registered. Conclusions: One tenth of the patients with CHKF required hospitalization, of which more than half were <1 year of age. The most frequent clinical manifestations were fever, rash, vomiting, irritability, arthralgia, and bullous lesions. Leukopenia was significantly more frequent in those ≤1 year of age. Age <3 months, as well as vomiting, vesicular-bullous rash, shock, irritability, seizures, abdominal pain, and respiratory distress were significantly associated with the need for hospitalization. The most frequent complications were shock, myocarditis and encephalitis.
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Resumen En la actual pandemia por COVID-19, se han descrito manifestaciones poco frecuentes como la rabdomiólisis y la encefalomielitis aguda. Una de las presentaciones atípicas del SARS-CoV-2, es el singulto, que son contracciones repetitivas involuntarias de los músculos intercostales y del diafragma, cuyo origen puede ser gastrointestinal, neurogénico o infeccioso por tuberculosis e influenza, entre otros. En el presente reporte se describen los casos de 2 pacientes cuyo síntoma principal para el diagnóstico de infección por SARS-CoV-2 fue el singulto, asociado con un patrón de afección pulmonar bilateral; a propósito de los casos, se incluye una revisión en la literatura de diferentes pacientes y de los factores relacionados en cada uno.
Abstract In the current COVID-19 pandemic, unusual manifestations such as rhabdomyolysis and acute encephalomyelitis have been described. One of the atypical presentations of COVID-19 is hiccups, which are involuntary repetitive contractions of the intercostal muscles and diaphragm, whose origin can be gastrointestinal, neurogenic, or infectious due to tuberculosis, influenza, among others. This report describes the cases of two patients in whom the main symptom for the diagnosis of SARS-CoV-2 infection, was hiccups associated with a pattern of bilateral pulmonary involvement; a review of the literature is included.
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Introducción: la arteritis de células gigantes es la vasculitis de vaso grande más frecuente y se ve predominantemente en adultos ma-yores de 50 años. El diagnóstico es en base a la clínica que se compone de cefalea, polimialgia reumática, sensibilidad en relación a la arteria temporal, compromiso del estado general, entre otras cosas, más laboratorio que se evidencia reactantes de fase aguda elevados y anemia y se confirma con biopsia de arteria temporal. Métodos: reporte de un caso de una paciente con debut con cefalea y aumento de volumen facial, lo que conllevó un diagnóstico erróneo de celulitis facial. Debido a esta presentación atípica, se retrasó el diagnóstico de arteritis de la temporal y tratamiento oportuno. Resultados: la arteritis de células gigantes es una patología que posee un gran rango de presentaciones atípicas, lo que ocurre en hasta un 38% de los pacientes que poseen la enfermedad, manifestaciones que incluyen neuralgia del trigémino, infartos linguales, aneurismas aórticos, edema facial, entre otros. Conclusión: es muy relevante conocer las presentaciones atípicas de esta patología que son muy frecuentes de encontrar en los pacientes y conocerlas nos permite aumentar nuestra sospecha clínica permitiendo un diagnóstico y tratamiento oportuno, evitando consecuencias irreversibles por el retraso diagnóstico.
Introduction: giant cell arteritis is the most frequent large vessel vasculitis and is seen predominantly in adults over 50 years. The diag-nosis is based on the clinic that is composed of headache, polymyalgia rheumatic, sensitivity near the temporal artery, compromise of the general condition, among other things, added to a laboratory that is evidenced like severe acute phase reactants and anemia and finally, is confirmed with temporal artery biopsy. Methods: a case report of a patient who debuted with headache and increased facial volume that led to a wrong diagnosis of facial cellulite. Because of this atypical presentation of the disease, the diagnostic took more time than usual and delayed the accurate diagnosis and timely treatment; this could have caused irreversible consequences. Results:giant cell arteritis has a wide range of atypical presentations; this may occur even up to 38% of patients that have this disease; manifes-tations include: trigeminal neuralgia, lingual infarct, aortic aneurysm, facial edema, and other symptoms. Conclusion: it is important to study the atypical presentations of this pathology because they are usually founded in patients. If we are informed about the atypical presentations, we can increase our clinical suspicion, and that allows us to get the right diagnosis and opportune treatment, avoiding irreversible consequences because of a late diagnosis.
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Humans , Female , Aged , Rheumatology , Giant Cell Arteritis , Edema , Patients , Polymyalgia Rheumatica , Vasculitis , Biopsy , Acute-Phase Reaction , Face , Headache , AnemiaABSTRACT
Background: To define the clinical profile of Chikungunya in infants admitted at a District Hospital in South India.Methods: All infants admitted in Government District Headquarters Hospital, Namakkal from January 2019 to December 2019 with fever (defined as axillary temperature > 99.6 F) and any one of the following features; seizure, loose stools, peripheral cyanosis, skin manifestations or pedal edema in children less than one year with chikungunya IgM ELISA positive were included in this study. Details of disease from onset of illness till admission were noted. This was a descriptive observational study.Results: Fifty-six (46) infants were included in this study, out of it 27(58.69%) were males and 19(41.30%) were females. 7(15.21%) infants were less than 1 month of age, 21(45.65%) were 2-6 months old and 18(39.13%) were 7-12 months old. Fever was invariably present but associated constitutional symptoms in infants consisted of lethargy or irritability and excessive cry. The most characteristic feature of the infection in infants was acrocyanosis and symmetrical erythematous rash were noted in most infants. Erythematous macules and patches were observed which later progressed to morbilliform rashes.Conclusions:Atypical clinical manifestations of chikungunya infection in infants as compared to older children to be carefully observed for its proper management. The morbidity and mortality of the disease may be avoided by the rational use of drugs and close monitoring of all infants.
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RESUMEN El Chikungunya es una arbovirosis que puede ser transmitida a los humanos por mosquitos del género Aedes. La enfermedad resultante se conoce como "fiebre chikungunya", cuyo nombre se deriva de un vocablo en makonde; lengua utilizada por un grupo étnico ubicado en el sudeste de Tanzania y norte de Mozambique. Una de sus manifestaciones atípicas puede ser de tipo dermatológico. En este trabajo se confirma su diagnóstico en un lactante de 6 meses de edad, mediante el estudio serológico específico para el virus CHIKV. El bebé fue tratado según el protocolo de medidas sintomáticas: hidratación y reposo. A los 10 días del inicio de los síntomas se logró la regresión del cuadro clínico. El lactante se atendió en una unidad básica de salud, del distrito de Santo Antonio, municipio de Pedra, estado de Pernambuco, Brasil; como parte de la colaboración cubana dentro del Programa "Más Médicos". Por su poca incidencia y forma de presentación atípica, consideramos importante la presentación de este caso.
ABSTRACT Chikungunya is an arbovirus transmitted to humans by Aedes mosquitoes. The resulting disease is known as "chikungunya fever", derived from Makonde language, spoken by an ethnic group from southeastern Tanzania and northern Mozambique. One atypical manifestation can be dermatological. In this work, diagnosis was confirmed in an 6 months infant, by a specific serological study for the CHIKV virus. Baby was treated, according to the protocol for symptomatic measures: hydration and rest. Regression of the clinical picture was achieved after 10 days of symptoms onset. The infant was treated in a basic health unit, in the district of Santo Antonio, municipality of Pedra, state of Pernambuco, Brazil; as part of the Cuban collaboration within the "Mas Médicos" Program. Due to the atypical presentation form and the low frequency of its occurrence, we considered this case is significant for this work.
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Background: Dengue is a viral disease which has grown dramatically over the years and has emerged as a public health issue requiring intervention to curb its spread. Favorable environment, abundance of vector, and lack of hygiene are leading to unprecedented spread of the disease. Objectives: The objectives were to study the prevalence of various manifestations of dengue fever. Materials and Methods: The study was conducted at Sarojini Naidu Medical College, Agra, during the outbreak from August to November 2015. During the study period, we observed a total of 131 patients. The serology included dengue immunoglobulin (Ig)-M, IgG, and non-structural protein 1 antigen. This study is a hospital-based retrospective study. All the data were expressed in percentage. Results: In this study, we found that cutaneous manifestation was seen in 22.9%, bleeding manifestation in 21.37%, polyserositis in 20.61%, fever in all patients 100%, thrombocytopenia platelet count <10,000 in 71.67%, organomegaly in 25.19%, and gallbladder wall thickening in 6.1%. Atypical manifestation such as hepatic coma, acute respiratory distress, seizure, and chest pain (myocarditis) was also seen in some patients. In this study, 62.59% affected patients were young male in the age group of 21 to 50 year thus it showed that dengue is more prevalent in young male population. Conclusion: The problem of dengue is ginormous in our country; the problem is multiplied due to humongous population, poor hygiene, lack of medical and diagnostic facilities, inadequate vector control measures, and lack of awareness among the population. Hence, future studies should be aimed to identify various atypical manifestations as well as early treatment protocols for timely intervention so as to halt the disease progression.
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Abstract INTRODUCTION: Chikungunya infection presents with distinct clinical features depending on the patient age group. METHODS: Medical records of children with positive IgM for the chikungunya virus who were hospitalized in a pediatric ward in Fortaleza, Ceará, Brazil were analyzed. RESULTS: Fourteen children with a median age of 4 months (36 days to 15 years) were included. All patients presented with fever persisting for an average of 5 days. The joints were involved in 6 (42.8%) children, and 8 (57.1%) children presented with bullous rash. CONCLUSIONS: Systemic involvement and atypical clinical manifestations characterize severe forms of chikungunya infection in children.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Chikungunya Fever/complications , Chikungunya Fever/diagnosis , Chikungunya Fever/blood , Severity of Illness Index , HospitalizationABSTRACT
Background: Malaria is fast emerging as a number one infectious disease with high morbidity and mortality across the globe. It’s being transmitted across 108 countries containing 3 billion populations (40% of world’s populations) with more than 3 million deaths per year. India is an endemic country for malaria with an estimated 70-100 million1 cases per year. 45-50% of them are due to Plasmodium falciparum (Pf). Pf is responsible for majority of severe and fatal malaria though death due to Plasmodium vivax mono infection have also been reported. Symptoms and sign are highly non-specific in malaria making it more of a clinical diagnosis more than a laboratory diagnosis. Presentation may vary at times and can be quite confusing as malaria is a multisystem disease. Authors’ idea was to study the variable manifestations in confirmed cases of malaria patients at our hospitalMethods: A hospital based cross sectional study was conducted for a period of one year-from 01-08-2015 to 31-07-2016 based on authors’ hospitals records (case sheets with demography profile, clinical features, investigations and treatment outcome).Results: A total of 369 patients positive for malaria parasite were included in the study. 369 were smear positive-219 positive for Plasmodium vivax, 127 were P. falciparum type and 23 were for both. Majority were males (64.50%) and belonged to the age group of 21-50 years (58.84%). They were admitted in post monsoon months (60.43%). Of them 46.44% had classical symptoms of malaria. All the patients had received mainly artemisinin combination therapy (ACT) and 91.87% patients recovered in 7-28 days. The mortality rate was nearly 5.69%.Conclusions: The present study was useful to know the varied manifestations of malaria and hence will be useful in making a clinical diagnosis of malaria.
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La fiebre chikungunya es una enfermedad tropical transmitida a los humanos mediante la picadura del mosquito Aedes aegypti y Aedes albopictus. Se manifiesta por fiebre alta, cefalea, mialgias y artralgias. Generalmente tiene un comportamiento benigno; sin embargo, se han reportado casos con manifestaciones atípicas y mortales. Es una virosis emergente del siglo XXI que en el Ecuador se convirtió en una epidemia en el año 2014. Reportamos un caso de una paciente de sexo femenino, 52 años de edad, residente en Quito (Ecuador) que presenta dolor abdominal, dolor torácico, artralgias, mialgias y alza térmica. Fue tratada por pancreatitis aguda de origen a determinar; no obstante, por los antecedentes epidemiológicos y el cuadro sintomático sugerente, se solicitó IgM (inmunoglobulina M) para chikungunya que fue positiva. Se la trató mediante hidratación y analgésicos; tuvo una adecuada respuesta sintomática.
Chikungunya fever is a tropical disease transmitted to humans by the mosquito bite Aedes aegypti and Aedes albopictus. It is characterized clinically by causing high fever, headache, myalgias and arthralgias; usually has a benign behavior, but cases with atypical manifestations that produce mortality are reported. It is an emerging virus in the 21st century. We report a case of a 52-year-old female patient living in Quito, Ecuador, with abdominal pain, chest pain, arthralgia, myalgias and fever. It was treated by acute pancreatitis of origin to determine, however by epidemiological antecedents and suggestive clinical, we decided to request IgM for chikungunya which was positive. The patient received treatment with hydration and analgesia, with adequate clinical response
Subject(s)
Humans , Female , Middle Aged , Pancreatitis , Chikungunya Fever , Myocarditis , Arthralgia , Myalgia , Non-ST Elevated Myocardial InfarctionABSTRACT
Various types of neurological manifestations are described in P. falciparum/vivax malaria of which Guillian Barre syndrome and its variant like Miller Fisher Syndrome (MFS) and Acute Motor Axonal Neuronopathy (AMAN). We are reporting such an unusual case who presented with five days history of fever and weakness of three days duration. On investigations it turned out to be acute MFS/AMAN overlap with peripheral blood showing mixed infection having heavy parasitaemia of P. falciparum and P. vivax combine. All other causes of acute polyneuropathy were ruled out by history and relevant examination. Patient improved with Artemisinin based Combination Therapy (ACT) and other supportive measures.
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Dengue is a worldwide condition spread throughout the tropical and subtropical zones between 30 degrees north and 40 degrees south. It is endemic in South East Asia, the pacific, East and West Africa, the Caribbean and the Americas. Dengue outbreaks are occurring almost every three yearly in Delhi for the last 12 years. The latest outbreak was in the year 2006, which started late in August, peaked in the month of October and lasted till late November. We describe here the clinical, hematological and biochemical data of 70 patients of dengue fever diagnosed as per WHO criteria in Lok Nayak Hospital, New Delhi during this outbreak. Hematological parameters were estimated by automated counter and dengue serology was done by capture ELISA technique. The results displayed widespread effect of dengue fever on hematological and biochemical profile. Some of our patients also had atypical dengue manifestations. These results suggest that dengue fever is a major public health problem which can lead to significant morbidity and can even be fatal at times. All efforts should be made to prevent it.