RESUMO
Ebola virus is transmitted to people as a result of direct contact with body fluids containing virus of an infected patient. The incubation period usually lasts 5 to 7 d and approximately 95% of the patients appear signs within 21 d after exposure. Typical features include fever, profound weakness, diarrhea, abdominal pain, cramping, nausea and vomiting for 3-5 days and maybe persisting for up to a week. Laboratory complications including elevated aminotransferase levels, marked lymphocytopenia, and thrombocytopenia may have occurred. Hemorrhagic fever occurs in less than half of patients and it takes place most commonly in the gastrointestinal tract. The symptoms progress over the time and patients suffer from dehydration, stupor, confusion, hypotension, multi-organ failure, leading to fulminant shock and eventually death. The most general assays used for antibody detection are direct IgG and IgM ELISAs and IgM capture ELISA. An IgM or rising IgG titer (four-fold) contributes to strong presumptive diagnosis. Currently neither a licensed vaccine nor an approved treatment is available for human use. Passive transfer of serum collected from survivors of Junin virus or Lassa virus, equine IgG product from horses hypervaccinated with Ebola virus, a "cocktail" of humanized-mouse antibodies (ZMapp), recombinant inhibitor of factor VIIa/tissue factor, activated protein C, RNA-polymerase inhibitors and small interfering RNA nano particles are among the therapies in development. Preclinical evaluation is also underway for various vaccine candidates. One is a chimpanzee adenovirus vector vaccine; other vaccines involve replication-defective adenovirus serotype 5 and recombinant vesicular stomatitis virus.
RESUMO
Tuberculosis is highly prevalent amongst children in India. Contact survey has not received much attention in the Revised National Tuberculosis Control Program guidelines. This study was conducted to look for tuberculosis in asymptomatic family members of pediatric tuberculosis patients at a government hospital attached to a medical college in Central India. 168 siblings and 162 parents of 86 index cases of tuberculosis were studied. 64 tuberculosis infected siblings and 7 sputum positive parents were identified.
RESUMO
La Enfermedad de Chagas (ECh) usualmente es transmitida al hombre por la penetración cutánea de parásitos contenidos en las heces de vectores hematófagos conocidos como chipos. Sin embargo existen otros mecanismos de transmisión. Se presenta el primer caso diagnosticado del brote de ECh agudo de transmisión oral, ocurrido en diciembre 2007 en una escuela de Caracas. Escolar de nueve años, femenino procedente de Caracas, hospitalizada con fiebre diaria 39-40°C y escalofríos de tres semanas de evolución, decaimiento, mareos, vómitos, astenia, mialgias, adenopatías cervicales, hepatomegalia, edema facial y en miembros inferiores. Los exámenes de laboratorio mostraron linfomonocitosis, serologías negativas para mononucleosis y dengue. En el frotis sanguíneo para el despistaje de malaria se encontró un tripomastigote de Trypanosoma cruzi. ELISA-IgM, ELISA-IgG, hemaglutinación indirecta, reacción en cadena de la polimerasa, cultivo e inoculación en ratones, fueron positivos para ECh. A los pocosdías se detectaron casos similares y se realizó el vínculo epidemiológico que permitió el reconocimiento de una epidemia urbana de ECh de transmisión oral. La paciente recibió nifurtimox y evolucionó satisfactoriamente. En la forma oral de transmisión de la ECh no existe signo de puerta de entrada, las manifestaciones clínicas, como la fiebre alta y prolongada y el edema, suelen ser comunes a otras patologías. En pacientes con fiebre de origen desconocido debe incluirse el frotis sanguíneo y la detección de IgM e IgG específicas para ECh como parte del plan diagnóstico. Se describe en forma pormenorizada el primer caso, considerado caso índice del brote de Chagas agudo adquirido por ingestión de alimentos en un colegio del municipio de Chacao en Caracas.
Chagas disease (ChD) is usually transmitted to man by cutaneous penetration of parasites contained in the feces of haematofagous vectors known as kissing bugs or chipos. However, other transmission mechanisms may occur. Herein, we report the first diagnosed case of an epidemic outbreak of acute oral transmitted ChD occurred in December 2007 in a school of Caracas. A 9 year old schoolgirl, coming from Caracas, was hospitalized with daily fever 39-40°C and chills of three weeks duration, sickness, vomitting, astenia, mialgias, cervical adenopathies, hepatomegaly, facial and inferior members edema. The laboratory tests showed lymphomonocytosis, negative serologies for mononucleosis and dengue. In the blood smear done to rule out malaria, tripomastigote of Trypanosoma cruzi was found. ELISA-IgM, ELISA-IgG, indirect hemaglutination, polymerase chain reaction, culture and mice inoculation were all positive for ChD. Few days after, similar cases were detected and it was carried out the epidemiological link that allowed the recognition of an urban outbreak of ChD of oral transmission. The patient evolved satisfactorily after being treated with nifurtimox. In the oral form of transmission of the ChD, signs of entrance do not exist, the clinical manifestations as high and prolonged fever and edema are common to other pathologies. In patients with fever of unknown origin, blood smear as well as search for specific IgM and IgG for ChD should be included as part of the diagnosis. The first case is described in detailed form, considered index case of the outbreak of acute Chagas acquired by food ingestion in a school of Chacao's county in Caracas.