Caracterización sociodemográfica y clínica de pacientes diagnosticados con dengue y chikungunya en Nariño, Colombia / Clinical and socio-demographic characterization of patients diagnosed with dengue and chikungunya in Nariño, Colombia

RESUMEN Introducción: Existen más de 390 millones de personas infectadas y 20 000 muertes anualmente a causa del dengue en el mundo. El chikungunya ocasionó una larga epidemia en las Américas con más de 2 millones y medio de casos hasta el 2017. Objetivo: Identificar las características sociodemográficas y clínicas de los casos de dengue y chikungunya informados para el periodo 2014-2017 en Nariño, Colombia. Métodos: Se realizó un estudio observacional, descriptivo, de corte transversal. Se revisaron retrospectivamente las bases de datos del Instituto Departamental de Salud de Nariño y del Hospital Universitario Departamental de Nariño. Resultados: Para el periodo de estudio hubo 2 514 hospitalizaciones por dengue y 460 por chikungunya. Se identificaron 22 casos de dengue grave, con una muerte para el año 2017. La revisión de expedientes de 1 735 pacientes con información completa reveló que las manifestaciones clínicas más frecuentes para dengue fueron: fiebre (100 por ciento), cefalea (84,6 por ciento) y mialgias (83,7 por ciento), seguidos de artralgias, rash y dolor abdominal. El sexo masculino predominó en los casos de diagnóstico de dengue (56,8 por ciento) y el femenino en el diagnóstico de chikungunya (52,0 por ciento. Tanto dengue como chikungunya fueron más frecuentes en la población mayor de 40 años con el 24,5 por ciento y 27,2 por ciento, respectivamente. Conclusiones: La sintomatología similar y los casos complicados resaltan la necesidad de contar con diagnósticos oportunos y diferenciales y capacitación al personal de salud, apoyados por entidades gubernamentales. Se requiere generar programas de intervención enfocados a edades productivas y en regiones con condiciones medioambientales propicias para el desarrollo de vectores transmisores de enfermedades(AU)

Introduction: More than 390 million dengue cases and 20 000 deaths due to this condition are reported worldwide every year. Chikungunya caused a large epidemic in the Americas with more than two and a half million cases until the year 2017. Objective: Identify the clinical and socio-demographic characteristics of the dengue and chikungunya cases reported for the period 2014-2017 in Nariño, Colombia. Methods: A cross-sectional observational descriptive study was conducted. A retrospective review was carried out of the databases at Nariño Departmental Health Institute and Nariño Departmental University Hospital. Results: During the study period there were 2 514 hospital admissions with dengue and 460 with chikungunya. A total 22 severe dengue cases and one death were identified for the year 2017. Review of the medical records of 1 735 patients with complete information revealed that the most common clinical manifestations of dengue were fever (100 percent), headache (84.6 percent) and myalgia (83.7 percent), followed by arthralgia, rash and abdominal pain. A predominance was found of the male sex in dengue cases (56.8 percent) and of the female sex in chikungunya cases (52.0 percent). Both conditions were more frequent in the population aged over 40 years, with 24.5 percent and 27.2 percent, respectively. Conclusions: The similar symptoms and the presence of complicated cases highlight the need for timely differential diagnosis and the training of the health personnel, with the support of government agencies. It is required to develop intervention programs aimed at working ages and regions with environmental conditions favorable for the spread of disease(AU)

Características clínicas de los pacientes con fiebre manchada de las Montañas Rocosas, infección por dengue y chikungunya / Clinical features of patients with Rocky Mountain spotted fever, dengue and chikungunya infection

Resumen Introducción: La distinción clínica entre infecciones arbovirales y las provocadas por rickettsias es crucial para iniciar el tratamiento médico apropiado. Objetivo: Comparar las diferencias entre fiebre manchada de las Montañas Rocosas (FMMR) y otras enfermedades transmitidas por vector (dengue y chikungunya) con presentación clínica similar e identificar los datos que pudieran ayudar al diagnóstico rápido de esas enfermedades. Métodos: Se evaluaron datos sociodemográficos, clínicos y de laboratorio de 399 pacientes de cinco hospitales y clínicas en Sonora, México, entre 2004 y 2016, con el diagnóstico confirmado por laboratorio de FMMR, dengue o chikungunya. Resultados: El grupo con FMMR presentó la mayor letalidad (49/63 muertes, 77.8 %), seguido por el de chikungunya (3/161, 1.9 %) y el de dengue (3/161, 1.9 %). Las diferencias clínicas consistieron en la presencia de exantema, edema y prurito; además, se documentaron diferencias en múltiples biomarcadores como plaquetas, hemoglobina, bilirrubina indirecta y niveles de sodio sérico. Conclusión: El exantema en palmas y plantas, edema y ausencia de prurito, aunados a niveles altos de bilirrubina directa y trombocitopenia severa pudieran ser indicadores útiles para diferenciar a pacientes con FMMR en etapas avanzadas de aquellos con dengue y chikungunya.

Abstract Introduction: Clinical distinction between arbovirus infections and those caused by rickettsia is crucial to initiate appropriate medical treatment. Objective: To compare the differences between Rocky Mountain spotted fever (RMSF) and other vector-borne diseases (dengue and chikungunya) with similar clinical presentation, and to identify data that could aid rapid diagnosis of these diseases. Methods: Sociodemographic, clinical and laboratory data of 399 patients from five hospitals and clinics of Sonora, Mexico, with laboratory-confirmed diagnosis of RMSF, dengue, or chikungunya between 2004 and 2016 were evaluated. Results: The RMSF group had the highest lethality (49/63 deaths, 77.8 %), followed by the chikungunya group (3/161, 1.9 %) and the dengue group (3/161, 1.9 %). Clinical differences included the presence of rash, edema, and pruritus; in addition, differences in multiple biomarkers such as platelets, hemoglobin, indirect bilirubin, and serum sodium levels were documented. Conclusion: Rash on the palms and soles, edema and absence of pruritus, together with high levels of direct bilirubin and severe thrombocytopenia could be useful indicators to differentiate patients at RMSF advanced stages from those with dengue and chikungunya.

Use of Cerebrospinal Fluid for the Diagnosis of Neuroinvasive Dengue, Zika, and Chikungunya: A 19-year systematic review

Abstract INTRODUCTION: Cerebrospinal fluid analysis contributes to the diagnosis and neuropathogenesis of neuroinvasive arboviruses. Neurological complications caused by dengue, Zika, and chikungunya infections have high clinical relevance because of their high potential to cause death or neurological deficits. We aimed to evaluate the use of cerebrospinal fluid assays for diagnostic support in neurological disorders associated with dengue, chikungunya, and Zika infections. METHODS: A systematic review was carried out by searching the electronic databases LILACS, PubMed, Scopus, and Embase for articles written in English, Portuguese, or Spanish in the last 19 years. Published studies were reviewed using the terms "dengue," "Zika", "chikungunya", alone or in combination with "cerebrospinal fluid" in the period from 2000 to 2019. RESULTS: A total of 98,060 studies were identified; of these, 1.1% (1,041 studies, 58,478 cases) used cerebrospinal fluid assays for neurological investigations. The most frequent neurological disorders included encephalitis (41.4%), congenital syndromes (17%), and microcephaly associated with Zika virus infections (8.9%). Neuroinvasive disorders were confirmed in 8.03% of 58,478 cases by specific cerebrospinal fluid analyses. The main methods used were IgM-specific antibodies (66%) and reverse transcription-polymerase chain reaction (10%). The largest number of scientific papers (29%) originated from Brazil, followed by India (18.4%) and the United States (14.4%). CONCLUSIONS: Although cerebrospinal fluid analysis is of great importance for increasing neurological diagnostic accuracy and contributes to the early diagnosis of neuroinvasive dengue, chikungunya, and Zika infections, it is underused in routine laboratory investigations worldwide.

Long-Term Persistence of Serum-Specific Anti-Chikungunya IgM Antibody - A Case Series of Brazilian Patients

Abstract The persistence of serum-specific anti-chikungunya IgM antibodies (CHIKV-IgM) can vary after chikungunya fever (CHIK) infection. However, the factors related to its production are not yet known. We described a case series drawn up from data collected from 57 patients between 12 and 36 months after the acute phase of CHIK infection in Northeastern Brazil. CHIKV-IgM was detectable in 7/57 (12.3%) patients after 28.3 months of infection. No frequency differences in chronic musculoskeletal manifestations and underlying conditions were detected between patients with or without CHIKV-IgM. CHIKV-IgM was detected for up to 35 months in Brazilian patients after CHIK infection.

Analytical and clinical performance of molecular assay used by the Brazilian public laboratory network to detect and discriminate Zika, Dengue and Chikungunya viruses in blood

ABSTRACT In response to the Zika epidemics in Brazil, the ZDC molecular assay (Bio-Manguinhos) was developed and registered at the Brazilian Regulatory Agency of Health Surveillance - ANVISA. The circulation of Zika (ZIKV) Dengue (DENV) and Chikungunya (CHIKV) viruses and their clinical similarities are challenges to correctly diagnose these viruses. The simultaneous detection of ZIKV, DENV and CHIKV is an important tool for diagnosis and surveillance. Here, we present the analytical and clinical performance evaluation of ZDC molecular assay (Bio-Manguinhos) at the public health laboratories three years after its registration at ANVISA. The clinical performance demonstrates the ZDC molecular assay (Bio-Manguinhos) has 100% sensitivity and 100% specificity to detect and discriminate ZIKV, CHIKV, and DENV from clinical plasma samples. The ZDC molecular assay (Bio-Manguinhos) results were highly reproducible and no cross-reactivity was seen during testing with a panel of other infectious agents. In conclusion, the ZDC molecular assay (Bio-Manguinhos) is an accurate and reliable tool to monitor Zika, dengue and chikungunya infections in countries like Brazil with simultaneous circulation of the three viruses.

Update on the treatment of musculoskeletal manifestations in chikungunya fever: a guideline

Abstract Since the emergence of the chikungunya virus in Brazil in 2014, more than 700,000 cases have been reported throughout the country, corresponding to one-third of all cases reported in the Americas. In addition to its high attack rates, resulting in hundreds of thousands of cases, the disease has high chronicity rates with persistent joint manifestations for more than 3 months, which can spread to more than half of the patients affected in the acute phase. Pain associated with musculoskeletal manifestations, often disabling, has an effect on patients' quality of life at different stages of the disease. Currently, the challenge faced by specialists is identifying the best therapy to be instituted for symptom relief despite the limited number of published intervention studies. In 2016, a multidisciplinary group published pharmacological treatment protocols for pain in patients with chikungunya, which was incorporated into the guidelines for clinical management of the Brazilian Ministry of Health in 2017; in that same year, a consensus was published by the Brazilian Society of Rheumatology about diagnosis and treatment. After 5 years of experience with chikungunya epidemics, in 2019, specialists involved in the protocols of the Brazilian Society of Rheumatology and Brazilian Ministry of Health prepared an update with the main objective of developing flowcharts for the therapeutic approach of musculoskeletal manifestations in adult patients to enable specialists at different levels of healthcare to spread and apply this guideline in a systematic and simplified manner.

Acute disseminated encephalomyelitis (ADEM) associated with mosquito-borne diseases: Chikungunya virus X yellow fever immunization

Abstract Acute disseminated encephalomyelitis (ADEM) is a demyelinating autoimmune neuropathic condition characterized by extensive bilateral and confluent lesions in the cerebral white matter and cerebellum. The basal ganglia and gray matter may also be involved. In most cases, the symptoms are preceded by viral infection or vaccination. In this report, we present a case of ADEM associated with optic neuritis presenting alongside two potential triggering factors: chikungunya virus infection and yellow fever immunization.

Manejo clínico da suspeita de febre de Chikungunya: conhecimento de profissionais de saúde da atenção básica / Manejo clínico de la fiebre de Chikungunya sospecha: conocimiento de profesionales de salud de atención básica / Clinical management of suspected Chikungunya fever: health professionals knowledge of basic attention

Objetivo: identificar o conhecimento de profissionais de saúde de unidades básicas de saúde da família sobre o manejo clínico da suspeita de febre de Chikungunya. Método: realizou-se um estudo transversal com 31 profissionais de saúde de unidades básicas e saúde da família, localizadas no Município de Quixadá-Ceará, nos meses de janeiro e fevereiro de 2018. Resultados: quase todos relatam que ao avaliar sinais de gravidade, critérios de internação e grupos de risco, se o paciente não apresentar sinais de gravidade, não tiver critérios de internação e/ou condições de risco, o mesmo deve permanecer em acompanhamento ambulatorial; se o paciente for apenas do grupo de risco, o mesmo deve receber acompanhamento ambulatorial em observação; e se o paciente apresentar sinais de gravidade e/ou tiver critérios de internação, ele deve receber acompanhamento em internação. Conclusão: os profissionais de saúde possuem conhecimento satisfatório sobre o manejo clínico da doença baseado nas orientações do Ministério da Saúde

Objective: to identify the knowledge of health professionals of family health basic units on the clinical management of suspected chikungunya fever. Method: a cross-sectional study with 31 healthcare professionals of basic units and family health, located in the city of Quixadá - Ceará, in the months of January and February 2018. Results: almost all report to evaluate signs of severity, admission criteria and risk groups, if the patient does not show signs of seriousness does not meet criteria for hospitalization and risk conditions/or should stay in outpatient follow-up; If the patient is only a risk group, he/she must be referred to outpatient follow-up for observation; and if the patient shows signs of severity and/or admission criteria, he should receive follow-up in hospital. Conclusion: health professionals have satisfactory knowledge on the clinical management of the disease based on the guidelines of the Ministry of Health

Objetivo: identificar el conocimiento de la salud profesionales de unidades básicas de salud de la familiaenel manejo clínico de só pecha Chikungunya fiebre. Método: estudio transversal con 31 profesionales de la salud de unidades básicas y de salud familiar, ubicado em la ciudad de Quixadá - Ceará, em los meses de enero y febrero de 2018. Resultados: informe casi todos para evaluar signos de gravedad, grupos de criterios de admisión y el riesgo, si el paciente no no mostrar signos de seriedad no tienen criterios para las condiciones de la hospitalización y el riesgo/unidad organizativa, debe mantenerse en seguimiento ambulatorio; Si el paciente es sóloel grupo de riesgo, el mismo debe recibir seguimento ambulatorio de observación; y si el paciente muestra signos de criterios de severidad y/o admisión, deben recibir seguimento em hospitalización. Conclusión: profesionales de la salud tienen conocimiento satisfactorio em el manejo clínico de la enfermedad basada en las directrices del Ministerio de Salud

Avaliação da qualidade metodológica de diretrizes de vigilância e manejo clínico de dengue e chikungunya / Methodological quality assessment of guidelines for surveillance and clinical management of dengue and chikungunya / Evaluación de la calidad metodológica de directrices de vigilancia y manejo clínico del dengue y chikungunya

Resumo: A pesquisa objetivou avaliar a qualidade metodológica de diretrizes do Ministério da Saúde brasileiro, da Organização Pan-Americana da Saúde (OPAS) e da Organização Mundial da Saúde (OMS) sobre vigilância e manejo clínico de dengue e chikungunya. Trata-se de um estudo descritivo, no qual a ferramenta Appraisal of Guidelines for Research & Evaluation Reporting Checklist II (AGREE II) foi aplicada por quatro avaliadores, de forma independente e mascarada, para seis diretrizes. Cada avaliador atribuiu um escore de 1 (discordo totalmente) a 7 (concordo completamente) aos 23 itens dos domínios do AGREE II: escopo e propósito; envolvimento das partes interessadas; rigor no desenvolvimento; clareza da apresentação; aplicabilidade e independência editorial. As diretrizes de dengue da OPAS (média = 5,2, DP = 0,8) e da OMS (média = 4,5, DP = 0,5) obtiveram maiores pontuações globais, sendo recomendadas com modificações por todos os avaliadores, e a do Ministério da Saúde (média = 2,7, DP = 0,4) não foi recomendada por um deles. Já as pontuações das diretrizes de chikungunya foram baixas (médias variando de 2,2 a 3,0) independentemente do órgão que as elaborou. Os domínios com maior conformidade foram "clareza da apresentação" (mediana de 84,7%) e "escopo e propósito" (77,1%), e os de menor conformidade foram "independência editorial" (5,2%) e "rigor no desenvolvimento" (9,1%). O estudo identificou lacunas na qualidade metodológica das diretrizes relacionadas, principalmente, à transparência nos processos de busca, seleção das evidências científicas e formulação das recomendações, além de falta de clareza quanto ao financiamento e possíveis conflitos de interesses.

Abstract: The study aimed to assess the methodological quality of guidelines by the Brazilian Ministry of Health, Pan American Health Organization (PAHO), and World Health Organization (WHO) on surveillance and clinical management of dengue and chikungunya. This was a descriptive study in which the tool Appraisal of Guidelines for Research & Evaluation Reporting Checklist II (AGREE II) was applied by four evaluators in independent and masked fashion for six guidelines. Each evaluator assigned a score from 1 (disagree completely) to 7 (agree completely) to the 23 items in the AGREE II domains: scope and purpose; stakeholder involvement; rigor in the development; clarity of presentation; applicability; and editorial independence. The dengue guidelines by PAHO (mean = 5.2, SD = 0.8) and WHO (mean = 4.5, SD = 0.5) obtained the highest overall scores and were recommended with modifications by all the evaluators, while the Brazilian Ministry of Health guidelines (mean = 2.7, SD = 0.4) were not recommended by any of them. Meanwhile, the chikungunya guidelines scored low (means from 2.2 to 3.0) for all three agencies. The domains with the greatest conformity were "clarity of presentation" (median 84.7%) and "scope and purpose" (77.1%), while those with the lowest conformity were "editorial independence" (5.2%) and "rigor in development" (9.1%). The study identified gaps in the guidelines' methodological quality, mainly in transparency of the work processes, selection of scientific evidence, and formulation of recommendations, besides lack of clarity in financing and possible conflicts of interest.

Resumen: El objetivo de la investigación fue evaluar la calidad metodológica de las directrices del Ministerio de Salud (MS) brasileño, de la Organización Panamericana de la Salud (OPAS) y de la Organización Mundial de la Salud (OMS) sobre vigilancia y manejo clínico del dengue y chikungunya. Se trata de un estudio descriptivo, en el cual la herramienta Appraisal of Guidelines for Research & Evaluation Reporting Checklist II (AGREE II) fue aplicada por parte de cuatro evaluadores, de forma independiente y oculta, en seis directrices. Cada evaluador atribuyó una puntuación de 1 (en desacuerdo totalmente) a 7 (concuerdo completamente) a los 23 ítems de los dominios del AGREE II: alcance y propósito; implicando las partes interesadas; rigor en el desarrollo; claridad de la presentación; aplicabilidad e independencia editorial. Las directrices del dengue de la OPAS (media = 5,2, DP = 0,8) y OMS (media = 4,5, DP = 0,5) obtuvieron mayores puntuaciones globales, siendo recomendadas con modificaciones por todos los evaluadores, respecto a las del Ministerio de Salud (media = 2,7, DP = 0,4) no se recomendó por parte de uno de ellos. Ya las puntuaciones de las directrices de chikungunya fueron bajas (medias variando de 2,2 a 3,0), independientemente del órgano que las elaboró. Los dominios con mayor conformidad fueron "clareza de la presentación" (media de 84,7%) y "alcance y propósito" (77,1%), mientras que los de menor conformidad fueron "independencia editorial" (5,2%) y "rigor en el desarrollo" (9,1%). El estudio identificó lagunas en la calidad metodológica de las directrices relacionadas, principalmente, respecto a la transparencia en los procesos de búsqueda, selección de las evidencias científicas y formulación de las recomendaciones, además de la falta de claridad respecto a la financiación y posibles conflictos de intereses.

Paciente com Chikungunya evoluindo com Síndrome de Angústia Respiratória do Adulto grave / Chikungunya evolving with SRDA Chikungunya patient progressing to severe Adult Respiratory Distress Syndrome

Objetivo: Demonstrar casos de Chikungunya cujos paciente evoluíram com Síndrome da Angústia Respiratória do Adulto. Métodos: Estudo descritivo e documental cuja a amostra foi composta por pacientes internados em um hospital no município de Campos dos Goytacazes, diagnosticados com sorologia IgM positiva para febre do vírus Chikungunya, que evoluíram para Síndrome da Angústia Respiratória do Adulto. Foram feitas análises de prontuários e de imagens radiológicas, além de revisão de literatura. Resultados: Foram incluídos três pacientes no estudo, sendo que um evoluiu ao óbito e os outros dois obtiveram recuperação de suas funções após o quadro agudo da doença. Conclusão: A Chikungunya é uma doença recente em território nacional, com possível evolução para quadros graves, especialmente em sua fase aguda. Por essa razão, estudos aprofundados são necessários para maior conhecimento e entendimento da patologia e de suas factíveis complicações.

Objective: To report cases of Chikungunya that progressed with Acute Respiratory Distress Syndrome. Methods: This is a descriptive and documental study, the sample of which consisted of patients who were hospitalized, in the city of Campos dos Goytacazes, diagnosed with positive IgM serology for Chikungunya fever, which progressed to Acute Respiratory Distress Syndrome. Medical records and radiological images were analyzed, and literature reviewed. Results: Three patients were included in the study, with one of them progressing to death, and the other two having their functions recovered after acute illness. Conclusion: Chikungunya is a recent disease in the national territory, with possible progression to severe conditions, especially on its acute phase. For this reason, in-depth studies are necessary for a better knowledge and understanding of the pathology and its likely complications

Chikungunya in a kidney transplant recipient: a case report / Chikungunya em um receptor de transplante renal: relato de caso

ABSTRACT In 2004, a global spread of Chikungunya fever affected most tropical and subtropical regions of the world. In 2016, an outbreak occurred in Northeast Brazil with hundreds of cases documented. Solid organ transplant recipients have a modified immune response to infection and the clinical course is usually different from immunocompetent patients. The diagnosis can be challenging in this population. Most reports describe patients residing in endemic areas, although we must emphasize the importance of differential diagnosis in kidney transplanted travelers who visit endemic regions, such as Northeast Brazil. Here, we reported a case of a kidney transplant recipient that acquired Chikungunya fever after a trip to an endemic region at Northeast Brazil during the outbreak in 2016, with a good clinical evolution. We also present warning recommendations for travelers to endemic areas as additional measures to prevent disease outbreaks.

RESUMO Em 2004, um surto global de Chikungunya afetou a maioria das regiões tropicais e subtropicais do mundo. Em 2016, um surto ocorreu no Nordeste do Brasil com centenas de casos documentados. Receptores de transplantes de órgãos sólidos têm uma resposta imune modificada à infecção, e o curso clínico é geralmente diferente daquele em pacientes imunocompetentes. O diagnóstico pode ser desafiador nessa população. A maioria dos relatos descreve pacientes residentes em áreas endêmicas, embora devamos enfatizar a importância do diagnóstico diferencial em viajantes transplantados renais que visitam regiões endêmicas, como o Nordeste do Brasil. Aqui, nós relatamos o caso de um receptor de transplante renal que adquiriu febre Chikungunya após uma viagem a uma região endêmica no Nordeste do Brasil durante o surto de 2016, com uma boa evolução clínica. Também apresentamos recomendações de alerta para viajantes em áreas endêmicas, como medidas adicionais para prevenir surtos de doenças.

Manifestações oculares na febre Chikungunya / Ocular Manifestations of Chikungunya Fever

Resumo A febre Chikungunya é um problema de saúde pública mundial, com potencial para gerar epidemias de alta morbidade, visto que elevado número de pacientes pode apresentar sequelas articulares prolongadas e alterações oftalmológicas. As manifestações oftalmológicas podem estar presentes na fase aguda da doença ou ter início após várias semanas da instalação do quadro. Na literatura mundial é descrito desde alterações mais comuns e de fácil tratamento como conjuntivites até alterações mais complexas e que podem cursar com sequelas visuais graves como a retinite e neurite óptica.

Abstract Chikungunya fever is a world public health problem with the potential to generate epidemics of high morbidity, since a high number of patients may present prolonged joint sequelae and ophthalmological alterations. Ophthalmologic manifestations may be present in the acute phase of the disease or begin after several weeks of the onset of the disease. In the world literature is described from more common and easy to treat changes such as conjunctivitis to more complex changes and that can occur with severe visual sequelae such as retinitis and optic neuritis.

A localized outbreak of Chikungunya virus in Salvador, Bahia, Brazil

A localized Chikungunya virus (CHIKV; East/Central/South African genotype) outbreak (50 cases, 70% laboratory-confirmed; attack rate: 5.3 confirmed cases/100 people) occurred in a Salvador, Brazil neighborhood, between Apr-Jun/2017. Highly clustered cases in space and time, mostly along a single street, highlight an increased risk of CHIKV transmission among pockets of susceptible populations. This finding underscores the need for ongoing local level surveillance for arboviral outbreaks.

Clinical and laboratory profiles of children with severe chikungunya infection

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.

Neurite óptica secundária a infecção pelo Chikungunya Vírus / Optic neuritis secondary to chikungunya virus infection

RESUMO Apresentamos um caso de um paciente de 46 anos, sexo masculino com diagnóstico de neurite ótica em olho direito associado a infecção aguda por Chikungunya. Os sintomas iniciais eram dor e baixa acuidade visual em olho direito associado a febre e poliartralgia simétrica há uma semana. Ao exame a acuidade visual era de 20/60 em olho direito e 20/20 em olho esquerdo, fundoscopia evidenciou edema de papila à direita. Foi iniciado imediatamente pulsoterapia com metilprednisolona por 7 dias e foi observada melhora do quadro de neurite no seguimento de 1, 3 e 12 meses, porém melhora parcial da acuidade visual, Dentre as causas investigadas identificou-se sorologia anti Chikungunya IgM positivo.

ABSTRACT We present a case of optic neuritis secondary to Chikungunya virus infection. Male, 46 yo, initial symptoms were pain and low visual acuity in the right eye associated to fever and symmetrical polyarthralgia one week ago. At the examination the visual acuity was 20/60 in the right eye and 20/20 in the left eye, fundoscopy showed papillo edema on the right eye. Immediately initiated pulse therapy with methylprednisolone for 7 days and improvement of the neuritis was observed in the follow-up of 1, 3 and 12 months, but partial improvement of the visual acuity. Among the investigated causes, Chikungunya IgM positive serology was identified.

Chikungunya, enfermedad emergente en América Latina. Descripción de los primeros casos en Chile / Chikungunya, emerging disease in Latin America. Description of the first cases in Chile

Resumen Introducción: Chikungunya (CHIK) se introduce en América el año 2013 diseminándose rápidamente. En 2014, se diagnosticó el primer caso importado en Chile. Objetivos: Identificar pacientes con sospecha clínica de CHIK. Describir sus características clínicas y laboratorio. Pacientes y Métodos: Se enrolaron pacientes con sospecha de CHIK. Se confirmó mediante reacción de polimerasa en cadena (RPC), IgM o IgG CHIKV. Se aplicó encuesta con preguntas demográficas, características del viaje, manifestaciones clínicas y laboratorio a pacientes y médicos tratantes. Resultados: Se enrolaron 21 pacientes, confirmando CHIK en 16 que se analizaron; 12 mujeres (75%), promedio edad 39 años (27-52). Exposición más frecuente fue el Caribe y Sudamérica. El síntoma inicial fue artralgia en 63%. Los síntomas más frecuentes fueron mialgias y malestar general (100%), fiebre y poliartralgia (94%). La mediana de duración de artralgias 90 días (3-262 días) y en 53% > 3 meses. Las articulaciones más comprometidas fueron tobillos, manos y muñecas, 87% con dolor invalidante. La artritis duró más en hombres que en mujeres (p < 0,001). El 38% de pacientes presentó linfopenia y un paciente trombocitopenia leve. Hubo dos hospitalizaciones por cefalea y pielonefritis aguda. Conclusiones: Chikungunya debe sospecharse en viajeros que regresan febriles y con poliartralgias intensas. Medidas de prevención deben ser indicadas a viajeros a zonas de riesgo.

Background: Chikungunya (CHIK) was introduced in The Americas in 2013, spreading rapidly. In 2014, the first imported case was diagnosed in Chile. Aim: To identify patients with clinical suspicion of CHIK and describe their clinical and laboratory characteristics. Patients and Methods: Patients with suspected CHIK were enrolled. All were confirmed by PCR, IgM or IgG CHIK. A structured survey was applied, which included demographic questions, travel characteristics, clinical manifestations, and laboratory results. Results: 21 patients were enrolled and CHIK was confirmed in 16, who were further analyzed; 12 were female (75%), average age 39 years (27-52). The Caribbean and South Americawere the most frequent sites of exposure. In 63%, the initial symptom was arthralgia. Most frequent symptoms were myalgias, malaise (both 100%), fever, and polyarthralgia (both 94%). The median duration of arthralgias was 90 days (3-262); in 53% arthralgias lasted ≥ 3 months. Main joints involved were ankles, hands, and wrists; 87% reported invalidating pain. Arthritis lasted longer in men than in women (p < 0.001). 38% of patients presented lymphopenia and one patient mild thrombocytopenia. Two patients required hospitalization, one with severe headaches, the other with acute pyelonephritis. Conclusions: Chikungunya should be suspected in returning travelers presenting with fever and severe polyarthralgia. Travelers to endemic areas should apply prevention measures to avoid mosquito bites.

Elaboração de um instrumento de avaliação cardíaca para pacientes idosos com chikungunya / Elaboration of a cardiac evaluation instrument for elderly patients with chikungunya

A infecção viral denominada Chikungunya, conhecida pelos africanos "aqueles que se dobram" antes caracterizada predominantemente por febre e artralgias severas tem, no entanto, apresentado manifestações atípicas graves e os fatores de risco, como comorbidades e idade superior a sessenta anos, determinam a gravidade da doença. Alterações graves seriam uma ou mais síndrome sistêmica requerendo monitoramento das funções vitais. Complicações cardíacas são apontadas como causas primeiras de óbito, independente de antecedentes de doenças cardiovasculares. A identificação de um perfil clínico e laboratorial relacionado às formas atípicas e graves constitui uma ferramenta de prognóstico fundamental para o reconhecimento precoce e manejo dos pacientes idosos