Manifestaciones oftalmológicas del dengue, el zika y el chikungunya / Ophthalmic manifestations of dengue, zika and chikungunya

Las infecciones por arbovirus constituyen un reto significativo para los sistemas de salud. Cada vez se incrementa el reconocimiento de complicaciones del sistema nervioso central secundarias a ellas, lo que puede ser un dilema para su diagnóstico y tratamiento. Los arbovirus pueden alterar los mecanismos de inmunidad innatos del ojo al dañar las barreras óculo-hemáticas. En esta revisión nos propusimos caracterizar los principales hallazgos oftalmológicos de las enfermedades transmitidas por mosquito, como el dengue, el zika y el chikungunya, y su posible fisiopatología. Se realizó una búsqueda de la literatura sobre el tema en la base de datos de PubMED. En los pacientes con zika y chikungunya se reconocieron frecuentemente la conjuntivitis no purulenta y la queratitis. En los casos de dengue el edema macular y las hemorragias retinianas maculares fueron frecuentes; causaron disminución de la visión y defectos campimétricos; la vasculitis y coriorretinitis periférica podía ser asintomática si la mácula no estaba comprometida. Estuvieron implicados la trombocitopenia y otros procesos fisiopatológicos. En las enfermedades estudiadas se reportaron casos raros con parálisis de nervios oculomotores o neuritis óptica como respuesta autoinmune tardía. Recientemente se reportó el síndrome de zika congénito que incluyó múltiples anomalías del desarrollo. En los neonatos afectados se describió la atrofia macular, así como la pigmentación macular bilateral, la hipoplasia del nervio óptico, la catarata, entre otros. Existen diversas lesiones oculares secundarias a infecciones por dengue, zika y chikungunya que merecen reconocimiento, pues deterioran la función visual temporal o permanentemente(AU)

Arbovirus infections pose a significant challenge to health systems. Awareness of the secondary central nervous system complications caused by these infections is on the increase, which may be a dilemma for their diagnosis and treatment. Arboviruses may alter the innate immunity mechanisms of the eye by damaging blood-retinal barriers. The objective of this review was to characterize the main ophthalmological findings of mosquito-borne diseases, such as dengue, zika and chikungunya, and their possible physiopathology. A bibliographic search about the topic was conducted in the database PubMed. Non-purulent conjunctivitis and keratitis were frequently found in zika and chikungunya patients. Dengue cases often presented macular edema and macular retinal hemorrhage, which caused vision reduction, as well as campimetric defects. Vasculitis and peripheral chorioretinitis could be asymptomatic if the macula was not involved. Thrombocytopenia and other physiopathological processes were also present. Oculomotor nerve palsy and optic neuritis as a late autoimmune response were rarely reported in the diseases studied. Recent reports refer to congenital zika syndrome, which causes multiple developmental abnormalities. Macular atrophy, bilateral macular pigmentation, optic nerve hypoplasia and cataract, among other disorders, were described in affected neonates. A variety of ocular lesions secondary to dengue, zika and chikungunya infection deserve recognition, for they damage visual function either temporarily or permanently(AU)

Chikungunya: educación y prevención como pilares fundamentales para enfermedad sin cura / Chikungunya: education and prevention as fundamental support for disease without cure

Chikungunya virus is an alphavirus, member of the Togaviridae family, first discovered in Africa in 1952. Since then it caused sporadic outbreaks in Africa and Asia, but since 2000, outbreaks had been more frequent, being identified in Europe, America and the Caribbean. Chikungunya virus can cause chronic and incapacitating arthralgia, with an important morbidity, being considered as a relevant re-emerging public health problem. This review intends to update our knowledge in epidemiology, transmission, pathogenesis, treatment and vaccination strategies of Chikungunya virus. (AU)

Recommendations of the Brazilian Society of Rheumatology for diagnosis and treatment of Chikungunya fever. Part 1 - Diagnosis and special situations / Recomendações da Sociedade Brasileira de Reumatologia para diagnóstico e tratamento da febre chikungunya. Parte 1 - Diagnóstico e situações especiais

Abstract Chikungunya fever has become a relevant public health problem in countries where epidemics occur. Until 2013, only imported cases occurred in the Americas, but in October of that year, the first cases were reported in Saint Marin island in the Caribbean. The first autochthonous cases were confirmed in Brazil in September 2014; until epidemiological week 37 of 2016, 236,287 probable cases of infection with Chikungunya virus had been registered, 116,523 of which had serological confirmation. Environmental changes caused by humans, disorderly urban growth and an ever-increasing number of international travelers were described as the factors responsible for the emergence of large-scale epidemics. Clinically characterized by fever and joint pain in the acute stage, approximately half of patients progress to the chronic stage (beyond 3 months), which is accompanied by persistent and disabling pain. The aim of the present study was to formulate recommendations for the diagnosis and treatment of Chikungunya fever in Brazil. A literature review was performed in the MEDLINE, SciELO and PubMed databases to ground the decisions for recommendations. The degree of concordance among experts was established through the Delphi method, involving 2 in-person meetings and several online voting rounds. In total, 25 recommendations were formulated and divided into 3 thematic groups: (1) clinical, laboratory and imaging diagnosis; (2) special situations; and (3) treatment. The first 2 themes are presented in part 1, and treatment is presented in part 2.

Resumo A febre chikungunya tem se tornado um importante problema de saúde pública nos países onde ocorrem as epidemias. Até 2013, as Américas haviam registrado apenas casos importados quando, em outubro desse mesmo ano, foram notificados os primeiros casos na Ilha de Saint Martin, no Caribe. No Brasil, os primeiros relatos autóctones foram confirmados em setembro de 2014 e até a semana epidemiológica 37 de 2016 já haviam sido registrados 236.287 casos prováveis de infecção pelo chikungunya vírus (CHIKV), 116.523 confirmados sorologicamente. As mudanças ambientais causadas pelo homem, o crescimento urbano desordenado e o número cada vez maior de viagens internacionais têm sido apontados como os fatores responsáveis pela reemergência de epidemias em grande escala. Caracterizada clinicamente por febre e dor articular na fase aguda, em cerca de metade dos casos existe evolução para a fase crônica (além de três meses), com dor persistente e incapacitante. O objetivo deste trabalho foi elaborar recomendações para diagnóstico e tratamento da febre chikungunya no Brasil. Para isso, foi feita revisão da literatura nas bases de dados Medline, SciELO e PubMed, para dar apoio às decisões tomadas para definir as recomendações. Para a definição do grau de concordância foi feita uma metodologia Delphi, em duas reuniões presenciais e várias rodadas de votação on line. Foram geradas 25 recomendações, divididas em três grupos temáticos: (1) diagnóstico clínico, laboratorial e por imagem; (2) situações especiais e (3) tratamento. Na primeira parte estão os dois primeiros temas e o tratamento na segunda.

Neurological manifestations of Chikungunya and Zika infections / Manifestações neurológicas das infecções pelos vírus Zika e Chikungunya

ABSTRACT The epidemics of Chikungunya virus (CHIKV) and Zika virus (ZIKV) infections have been considered the most important epidemiological occurrences in the Americas. The clinical picture of CHIKV infection is characterized by high fever, exanthema, myalgia, headaches, and arthralgia. Besides the typical clinical picture of CHIKV, atypical manifestations of neurological complications have been reported: meningo-encephalitis, meningoencephalo-myeloradiculitis, myeloradiculitis, myelitis, myeloneuropathy, Guillain-Barré syndrome and others. The diagnosis is based on clinical, epidemiological, and laboratory criteria. The most common symptoms of ZIKV infection are skin rash (mostly maculopapular), fever, arthralgia, myalgia, headache, and conjunctivitis. Some epidemics that have recently occurred in French Polynesia and Brazil, reported the most severe conditions, with involvement of the nervous system (Guillain-Barré syndrome, transverse myelitis, microcephaly and meningitis). The treatment for ZIKV and CHIKV infections are symptomatic and the management for neurological complications depends on the type of affliction. Intravenous immunoglobulin, plasmapheresis, and corticosteroid pulse therapy are options.

RESUMO As epidemias provocadas pelo vírus Chikungunya (CHIK) e Zika vírus (ZIKV) têm sido consideradas as ocorrências epidemiológicas mais importantes da América. O quadro clínico da infecção por CHIK caracteriza-se por febre alta, exantema, mialgia, cefaléia e artralgia. Além do quadro clínico típico, manifestações atípicas como complicações neurológicas foram relatadas: meningo-encefalite, mielorradiculopatia, mielorradiculite, mielite, mieloneuropatia, síndrome de Guillain-Barre (GBS), entre outras. O diagnóstico é baseado em critérios clínicos, epidemiológicos e laboratoriais. Em relação aos sinais e sintomas da infecção pelo ZIKV, erupção cutânea (principalmente maculopapular), febre, artralgia, mialgia, cefaléia e conjuntivite são os mais comuns. Algumas epidemias que ocorreram recentemente na Polinésia Francesa e Brasil relataram condições mais severas, com envolvimento do sistema nervoso (GBS, mielite transversa, microcefalia e meningite). O tratamento para ZIKV e CHIK é sintomático, e o manejo das complicações neurológicas dependerá do tipo da afecção. Imunoglobulina venosa, plasmaférese, e pulsoterapia com corticosteróides são opções.

Choque séptico secundario a fiebre por chikungunya no congénita en un lactante menor: caso clínico / Septic shock secondary to non-congenital chikungunya fever in a young infant: a clinical case

Introducción A partir de julio de 2015, en el estado de Yucatán, México, se presentó un brote de chikungunya. Objetivo Analizar el curso clínico de un caso de chikungunya de trasmisión vectorial y proporcionar evidencia práctica que sirva para orientar impresiones diagnósticas y pronósticas futuras en áreas endémicas y períodos de brote. Reporte de caso Lactante de un mes de edad, sin antecedentes de importancia, quien presentó cuadro febril acompañado de eritema maculopapular, inicialmente tratado con antiinflamatorios no esteroideos. Evolucionó con hipoactividad, trombocitopenia severa y neutropenia sin linfopenia, dificultad respiratoria, disfunción hepática, convulsiones y posteriormente shock séptico con desenlace fatal. La IgM para chikungunya fue positiva en la paciente, mientras que en su madre fue negativa. En el hemocultivo creció Pseudomonas aeruginosa, por posible contaminación, sin descartarse una sepsis de origen mixto. Conclusiones Chikungunya es una enfermedad cuyas manifestaciones en los neonatos y lactantes pueden ser graves e incluso fatales. Es importante sospecharla en este grupo etario debido al riesgo de contacto vectorial, en presencia de fiebre sin foco aparente y manifestaciones cutáneas maculares o maculopapulares. Los antipiréticos se deben emplear con precaución, considerando la posibilidad de agravar el cuadro clínico subyacente, con potencial daño hepático y hematológico.

Introduction A chikungunya outbreak took place in the State of Yucatan starting in the second half of 2015 Objective To analyse the clinical course of a case of chikungunya in a previously healthy infant, providing practical evidence to guide future diagnoses and treatment during outbreak seasons in endemic areas Case report Clinical manifestation started with a sudden onset of fever and a diffuse macular-papillary erythema, originally treated in the community with non-steroidal anti-inflammatory drugs. Two days later, the fever relapsed with hypoactivity, severe thrombocytopenia and neutropenia (without lymphopenia), respiratory distress, liver dysfunction, sepsis, followed by septic shock with a fatal outcome. IgM test was positive to chikungunya, while her mother tested negative. Pseudomonas aeruginosa was isolated from the blood culture possible due to contamination, without ruling out the possibility of a mixed origin sepsis. Conclusions Chikungunya is a disease in which the manifestations in neonates and young infants can be severe, and even fatal. It is important to suspect it in this age group at risk of vector contact, in the presence of fever without apparent source of infection and cutaneous manifestations. It is important to use the antipyretics cautiously, considering the possibility of aggravating the underlying infection, and the potential hepatic and haematological damage.