ABSTRACT
La enfermedad de pie, mano boca es una patología frecuente de observar en niños menores de 5 años, generalmente producida por virus Coxsackies y Enterovirus. Existen presentaciones atípicas debido a serotipos recientemente descritos de estos virus, algunos de ellos se han reportado en pacientes adultos. Se presenta caso de paciente masculino de 19 años, con antecedentes de dermatitis seborreica facial en tratamiento, que desarrolla una presentación atípica del síndrome pie, mano boca en contexto de un brote de esta patología en su academia militar. Luego del análisis epidemiológico, clínico e histopatológico, se diagnostica eccema coxsackium, una patología infrecuente en este grupo etario que contiene algunas particularidades destacables en relación con su manejo y estudio.
The hand mouth foot syndrome is a common pathology observed in children under 5 years, usually caused by coxsackie virus and enterovirus. There are exuberant clinical presentations, due to infrequent and emerging serotypes of these viruses, some of them manifesting in adult patients. A case of a 19 year old patient is presented, with a history of seborrheic dermatitis of the face and scalp in treatment, who develops an atypical clinical presentation of the hand foot mouth syndrome, intensely affecting the areas of seborrheic dermatitis on the face, in the context of an outbreak of this pathology in his military academy. After the epidemiological, clinical and histopathological analysis, eczema coxsackium is diagnosed, an infrequent pathology in this age group that contains some remarkable peculiarities in relation to its management.
Subject(s)
Humans , Male , Adult , Coxsackievirus Infections/diagnosis , Coxsackievirus Infections/pathology , Eczema , Hand, Foot and Mouth Disease/diagnosis , Hand, Foot and Mouth Disease/pathologyABSTRACT
OBJECTIVE@#To discuss the myocardial expression of Spry1 and MAPK proteins of viral myocarditis (VMC), to reveal its mechanism of sudden death, and to provide guides for forensic identification of sudden cardiac death.@*METHODS@#Thirty Balb/c male mice were randomly divided into VMC group and control group, inoculated intraperitoneally with Coxsackievirus B3 and Eagel's solution, respectively. After the mice were sacrificed, the cardiac tissues of the mice were taken to proceed regular pathological examination. The changes of Spry1 protein, Spry1 mRNA and MAPK protein were detected by immunohistochemistry, Western blotting and real-time PCR.@*RESULTS@#Under light microscope, the pathologic changes included myocardial interstitial edema, inflammatory cells infiltration, myocardial necrosis, and focal and patchy necrosis of myocardial fiber in VMC group. The expression of Spry1 protein in VMC group was lower than that in control group (P < 0.05). There was slightly decreased expression of Spry1 of the mRNA level in VMC group (P > 0.05). But the MAPK protein expression in VMC group was higher than that in control group (P < 0.05).@*CONCLUSION@#The pathway of MAPK/ERK involving Spry1 protein accelerates the expression of collagen, which may contribute to arrhythmia, heart failure and even sudden cardiac death.
Subject(s)
Animals , Male , Mice , Adaptor Proteins, Signal Transducing/metabolism , Coxsackievirus Infections/pathology , Death, Sudden, Cardiac/pathology , Disease Models, Animal , Immunohistochemistry , Membrane Proteins/metabolism , Mice, Inbred BALB C , Mitogen-Activated Protein Kinases/metabolism , Myocarditis/virology , Myocardium/pathology , Phosphoproteins/metabolism , RNA, Messenger/metabolism , Random Allocation , Real-Time Polymerase Chain ReactionABSTRACT
La enfermedad de manos, pies y boca es causada por el virus coxsackie A es extremadamente contagiosa y de duración limitada. Es característica de niños y muy eventualmente en adultos. Se asocia a fiebre, malestar general, linfoadenopatías tras las cuales aparece una erupción vesicular localizada en la boca que se rompen originando úlceras superficiales y se acompañan de la aparición de pápulas eritematosas en las palmas de las manos, en las plantas de los pies, que pasan a vesículas y luego se ulceran. No requiere tratamiento específico, es autolimitada, con un tiempo de duración de 1 a 2 semanas. Se presenta un caso de paciente femenina de 52 años de edad quien consulta por presentar lesiones ulcerativas en la cavidad bucal acompañada con sintomatología general. Antecedentes familiares y personales no contributorios. La paciente refiere inicio de la enfermedad actual hace aproximadamente 6 días cuando aparecieron lesiones vesiculo - ulcerativas en la mucosa bucal, concomitante con fiebre y malestar general. Refiere haber tenido contacto con una nieta que presentó el mismo cuadro clínico. No ha recibido tratamientos anteriores. Al examen clínico extrabucal se observa en la piel de las manos y en los pies lesiones papulomatosas y algunas ulcerativas, que causan molestias a la paciente. Al examen intrabucal se observa lesiones de naturaleza ulcerativa ubicadas en mucosa de los carrillos y pilar anterior amigdalino. Se le indico tratamiento sintomático. Se destaca la importancia de este caso en su presentación clínica ya que es una enfermedad frecuente en la infancia y siendo inusual en pacientes de edad adulta
Hand, foot and mouth disease is caused by the virus coxsackie A, is extremely contagious and of limited duration. Is typical of children and very eventually in adults. It associates to fever, general discomfort, linfoadenopatía after which a vesicular eruption appears located in the mouth, they break originating superficial ulcers and they accompany with the appearance of wheal and flare in the palms of the hands, in the plants of the feet, which go on to bladders and then ulcerate. It does not need specific treatment, is autolimited, with a time of duration from 1 to 2 weeks. It is presented a case of 52-year-old female patient of age, who consults for presenting ulcerative injuries in the oral cavity accompanied with general symptomatology. Family and personal precedents are not contributers. The patient recounts the beginning of the current disease approximately 6 days ago when appeared ulcerative bladders injuries in mucous mouth, concomitant with fever and general discomfort. She recounts to have had contact with a granddaughter who presented the same clinical picture. She has not received previous treatments. In the clinical extrabuccal examination is observed in the hand's skin and in the feet papulomatosas and some ulceratives injuries, which cause inconveniences to the patient. In the intrabuccal examination is observed injuries of ulcerative nature located in mucous of the pulleys and previous prop amigdalina. It was indicate symptomatic treatment. Is outlined the importance of this case in its clinical presentation since it is a frequent disease in the infancy and being unusual in patients of adult age
Subject(s)
Humans , Female , Middle Aged , Hand, Foot and Mouth Disease/diagnosis , Exanthema/pathology , Coxsackievirus Infections/diagnosis , Coxsackievirus Infections/pathology , DentistryABSTRACT
Endomyocardial biopsy often fails to show myocardial inflammation for patients with clinically suspected myocarditis. The serum isoforms of troponin T (cTnT) level is a very sensitive marker of myocardial injury and it is elevated even in the absence of myocardial inflammation. We investigated the correlations for myocardial injury, virus titers and inflammation in acute viral infection. Using the murine coxsackievirus group B3 (CVB3) myocarditis model, the histopathologic findings and virus titers in mouse hearts were compared with the serum cTnT levels measured by ELISA at various time points. Viable virus titers in the hearts peaked at 3 days after infection (8.22+/-0.13 log10 PFU/100 mg of heart); they decreased at day 7 and no viable virus was detected from day 14. Myocardial inflammation was minimal at day 3, peaked at day 7 and markedly decreased at day 14. The individual serum TnT levels were significantly increased at day 3 (7.37+/-1.46 ng/ml), persisted to day 7 (0.73+/-0.08 ng/ml), and normalized at day 14. Serum cTnT levels were correlatable with virus titers in the heart (r=0.744, P <0.01), but the serum cTnT levels were not correlated with the degrees of inflammation. Using the less myocarditic strain of CVB3, similar relationships were observed between the changes for the serum cTnT levels and the heart virus titers. During the course of viral infection, myocardial injury precedes the pathologic evidence of inflammation, and the elevated cTnT levels provide evidence of myocardial injury even in the absence of any histologic findings of myocarditis.
Subject(s)
Animals , Female , Humans , Mice , Acute Disease , Coxsackievirus Infections/pathology , Enterovirus B, Human/isolation & purification , Heart/virology , HeLa Cells , Inflammation/immunology , Mice, Inbred BALB C , Myocardial Infarction/immunology , Myocarditis/immunology , Myocardium/immunology , Troponin T/blood , Virus ReplicationABSTRACT
To study the diagnostic method of slight viral myocarditis in the field of forensic pathology, slight viral myocarditis model was induced in Balb/c murine by coxsackie virus B3. Organs of hearts, livers, spleens, lungs and kidneys were examined through routine pathological methods. Pathological changes at different levels of these organs were observed. The results indicated that viral myocarditis was a kind of disease with multiple organ alterations and that the pathological observation and comprehensive analysis of multiple organs was one of the useful methods for diagnosing slight viral myocarditis.