Enfoque clínico del síndrome febril agudo en Colombia / Clinical approach to acute febrile syndome in Colombia

El síndrome febril agudo se refiere a un conjunto de enfermedades que cursan con fiebre en el contexto de exposición en áreas tropicales y que constituyen un motivo de consulta frecuente en el servicio de urgencias. Este artículo revisa el enfoque clínico del síndrome febril agudo en Colombia y de las enfermedades más prevalentes o graves que lo causan. Se presenta el enfoque sindromático y se establece una revisión sucinta de los síntomas principales, signos de alarma, tratamiento, prevención y notificación en el sistema de vigilancia en salud pública.

Acute febrile syndrome refers to a group of diseases with fever as a main symptom, in a context of living in or having been exposed to tropical climates. It is a frequent cause for consultation in the emergency room. This paper reviews the clinical approach to acute febrile syndrome and the most prevalent or severe causes. We present the syndromatic approach to the patient and a short review of the main symptoms, alarm signs, treatment, prevention and notification to the public health surveillance system of the most frequent causes.

Compromiso gastrointestinal agudo en pacientes con dengue por serotipo 4: Comunicación de un caso y revisión de la literatura / Acute gastrointestinal involvement in dengue disease by serotype 4: a case report and literature review

Dengue fever is the world's most important arboviral disease, presenting a wide clinical spectrum. We report for the first time in Peru, a case caused by dengue virus serotype 4 with significant gastrointestinal involvement (acute acalculous cholecystitis and acute hepatitis). In addition we carried out a review of the literature atypical presentation illustrating the importance of the characteristics of abdominal pain (right upper quadrant); presence of Murphy's sign, ultrasound, and liver enzymes levels, for appropriate diagnosis and clinical management.

El dengue es la arbovirosis más importante del mundo y causa un amplio espectro clínico. Presentamos el primer caso de dengue causado por el serotipo 4 (DENV-4) en Perú con compromiso gastrointestinal (colecistitis aguda alitiásica y hepatitis aguda moderada). Se presenta una revisión de la literatura médica sobre este tipo de presentación, enfatizando la importancia y características del dolor abdominal (hipocondrio derecho), el signo de Murphy, los hallazgos ultrasonográficos y la medición de las enzimas hepáticas para establecer el diagnóstico y manejo adecuado.

Pruebas de funcionalismo hepático en pacientes con infección viral aguda / Liver function tests in patients with acute viral infection / Testes de fungáo hepática em pacientes com infecgáo viral aguda

Las hepatitis víricas son producidas principalmente por virus de las hepatitis; sin embargo, otros virus han sido asociados a esta entidad clínica. Con el objeto de estudiar estas alteraciones hepáticas se estudiaron 130 pacientes con síntomas de infección viral aguda. Se les realizó una historia clínica y sus muestras de suero fueron procesadas por técnicas inmunoen-zimáticas y espectrofotométrícas para la determinación de anticuerpos específicos de los distintos virus y para pruebas de funcionalismo hepático. Se confirmó infección viral en 68 pacientes: 22 casos (32,4%) por virus dengue (VD); virus de varicela zoster (VVZ) 11(16,2%), virus de parotiditis (VP) 9 (13,2%); infección por citomegalovirus (CMV) 7 (10,3%), virus Epstein Barr (VEB) 4(5,9%), 13(19,1%) por virus de hepatitis A (VHA), 1 (1,5%) por virus de hepatitis B (VHB) y 1 (1,5%) por virus de hepatitis C (VHC). En todas las infecciones virales se observó aumento de ambas transaminasas; en la infección por virus de hepatitis predominó alaninaaminotransferasa (ALT) (p < 0,05). El resto de las infecciones estudiadas fue a expensas de aspartatoaminotransferasa (AST). La hiperbilirrubinemia producida por VHA fue estadísticamente significativa (p < 0,05) con respecto al resto de las infecciones. La fosfatasa alcalina (FA) y la gammaglutamiltranspeptidasa (GGT) también estuvieron alteradas y se destacó la hipoproteinemia en la infección por VD. Este estudio sugiere que las pruebas bioquímicas que miden el funcionalismo hepático, no sólo evalúan severidad y evolución de la enfermedad, sino que además pueden orientar sobre la etiología de la infección viral aguda.

Viral hepatitis is mainly caused by the hepatitis virus, but other viruses have been associated with this clinical entity. In order to study these liver disorders, 130 patients with symptoms of acute viral infection were analized. A complete medical history and serum samples were assayed by enzyme-linked immunoassay and spectrophotometer techniques for the determination of antibodies specific to different viruses and liver func-tion tests. Viral infection was confirmed in 68 patients: 22 cases (32.4%) for dengue virus (DV) 11 (16.2%) varicella zoster virus (VZV), 9 (13.2%) mumps virus (VP), 7 (10.3%) cytomegalovirus (CMV), 4 (5.9%) Ep-stein- Barr virus (EBV), 13 (19.1%) patients with hepatitis A virus (HAV), 1 (1.5%) infected with hepatitis B virus (HBV) and 1 (1.5%) with hepatitis C virus (HCV). All viral infections showed an increase in both transaminases; in hepatitis virus infection, alanineaminotransferase (ALT) (p < 0.05) predominated. The rest of the infections studied were at the expense of aspartate aminotransferase (AST). HAVhyperbilirubine-mia was statistically significant (p < 0.05) compared with other infections. Alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT) were also affected, and hypoproteinemia was stressed in DV infection. This study suggests that the biochemical tests that measure liver function, not only assess the severity and progression of the disease, but can also shed light on the cause of acute viral infection.

As hepatites virais sáo produzidas principalmente por virus das hepatites; entretanto outros virus tem sido associados a esta entidade clínica. Com o objetivo de estudar estas alteragóes hepáticas foram estudados 130 pacientes com sintomas de infecgáo viral aguda. Foi realizado um prontuário clínico e suas amostras de soro foram processadas por técnicas imunoenzimáticas e espectrofotométrícas para a determinagáo de anticorpos específicos dos diferentes virus e para testes de fungáo hepática. Confirmou-se infecgáo viral em 68 pacientes: 22 casos (32,4%) por virus dengue (VD); virus de varicela zoster (VVZ) 11(16,2%), virus de parotidite (VP) 9 (13,2%); infecgáo por citomegalovírus (CMV) 7(10,3%), virus Epstein Barr (VEB) 4(5,9%), 13 (19,1%) por virus de hepatite A (VHA), 1 (1,5%) por virus de hepatite B (VHB) e 1(1,5%) por virus de hepatite C (VHC). Em todas as infecgóes virais foi observado aumento de ambas as transaminases; na infecgáo por virus de hepatite predominou alanina aminotransferase (ALT) (p < 0,05). O resto das infecgóes es-tudadas foi as expensas de aspartato aminotransferase (AST); a hiperbilirrubinemia produzida por VHA foi estatisticamente significativa (p< 0,05) com relagáo ao resto das infecgóes. A fosfatase alcalina (FA) e a gamaglutamiltranspeptidase (GGT) também estiveram alteradas e se destacou a hipoproteinemia na infecgáo por VD. Este estudo sugere que os testes bioquímicos que medem a fungáo hepática, náo só avaliam severidade e evolugáo da doenga, mas também podem orientar sobre a etiologia da infecgáo viral aguda.

[TT virus infection among Iranian blood donors: its prevalence and relationship to serum alanine aminotransferase [ALT] leve]

TT virus [TTV] is a DNA virus and is proposed as a potential cause of non-A to E hepatitis. We aimed to investigate, for the first time, the prevalence of TTV in Iranian healthy blood donors. Three hundred and twelve healthy Iranian blood donors were randomly selected and tested for TTV DNA by the seminested polymerase chain reaction method. Serum alanine aminotransferase [ALT] levels were determined in those infected and uninfected individuals that adequate serum were available. HBsAg or HCV antibody-positive subjects were excluded. Results: TT virus DNA was detected in 70 [22.4%] of the 312 subjects under study. ALT was elevated in 8 [18.2%] of the 44 TTV positive blood donors and in 8 [10.9%] of the 73 TTV negative blood donors. There was no significant difference between these two groups. TTV viremia is common among Iranian blood donors. Its prevalence in Iran is higher than US [1%] and most West-European countries and is comparable to China [28%] but lower than Thailand [37%] and Italy [42.4%]. Our data do not support the correlation between TTV viremia and elevated ALT level

Estudo clínico sorológico da hepatite aguda não-A não-B esporádica em Salvador-Bahia / Clinical study of acute hepatitis serological non-A non-B sporadic in Salvador, Bahia

O recente conhecimento das novas viroses hepatotrópicas, estimula o entendimento da história natural da hepatite induzida por estes agentes. Esse estudo objetivou a investigação clínica, bioquímica e sorológica, assim como a etiologia dos casos de hepatite aguda viral Não-A Não-B acompanhados num Centro de Referência para Doenças Hepáticas em Salvador-Bahia. Entre Julho/92 e Outubro/94, 147 pacientes com quadro clínico-laboratorial de hepatite aguda viral foram avaliados no Serviço de Gastro-Hepatologia. A suspeita de hepatite aguda viral se deu pelos achados clínicos clássicos da doença, assim como pela elevação da ALT superior a quatro vezes o limite máximo da normalidade. O VHA e VHB foram investigados através da determinação de anti-VHA IgM, anti-HBc IgM, AgHBs. Nos casos negativos para esses marcadores seguiuse a determinação de anti-CMV IgM, anti-EBV IgM, anti-VHC, antiVHE. O VHC-RNA por PCR foi realizado em todos os pacientes com hepatite Não-A Não-B e o VHG-RNA por PCR foi realizado nos pacientes negativos para o VHC-RNA. Dos 147 pacientes estudados, 53 (36,6%) foram relacionados ao VHA, 51 (34,7%) ao VHB, 13 (8,8%) ao VHC, 5 (3,4%) ao VHE, e 25 (17%) foram soro-negativos "pra todos os marcadores supracitados., (VHX). Nenhum desses pacientes foi positivo para EBV e CMV. No total, 43 pacientes foram considerados como hepatite aguda Não-A Não-B, sendo 5/43 (11,6%) pelo VHE, 13/43 (30,1%) pelo VHC, e 25/43 (58,1%) pelo VHX. Na "coorte" montada a partir do diagnóstico de hepatite Não-A Não-B, observamos que os 5 casos com soro-positividade para o VHE resolveram sua doença nos primeiros seis meses de acompanhamento. Nos pacientes com etiologia pelo VHC, 53,8°1 (7/13) normalizaram AL T nos primeiros seis meses de acompFnhamento, persistindo alterações ALT em 46,2% (6/13). O VHC-RNA permaneceu positivo após 6 meses de acompanhamento em 69,2% (9/13) pacientes sugerindo cronificação do processo independente dos valores de ALT...

Seropositividad de la infección por HCV y HBV, en estudiantes universitarios del Estado de Nuevo León, México / Positive serology for HCV and HBV infection in univertity students of the state on Nuevo Leon, Mexico

Antecedentes: La hepatitis viral es una enfermedad infectocontagiosa. Los pacientes infectados con virus de la hepatitis B (HBV) o con virus de la hepatitis C (HCV) pueden evolucionar a un estado crónico sintomático o asintomático que ocasiona cirrosis y un riesgo muy alto de carcinoma hepático. Objetivo: Los sujetos asintomáticos portadores del antígeno de superficie del HBV (Hbs-Ag) o de anticuerpos dirigidos contra HCV son potencialmente infectantes, por lo que desde el punto de vista de salud pública, es muy importante detectarlos. Métodos: En este trabajo se buscó la frecuencia de seropositividad de HBs-Ag y de anticuerpos anti-HCV en una población de 774 jóvenes de nuevo ingreso a la Facultad de Medicina de la Universidad Autónoma de Nuevo León, con una edad promedio de 188 años. Para detectar HBs-Ag se usó una prueba de ELISA de segunda generación y una prueba confirmatoria de neutralización. Los anticuerpos anti-HCV se midieron por un ELISA de segunda generación y por una prueba confirmatoria de un inmunoensayo en línea o RIBA. Tesultados: Se detectaron tres sueros positivos en HBs-Ag por ELISA, y sólo un suero (0.13 por ciento de las muestras analizadas) se confirmó por neutralización. En cambio se obtuvieron 12 sueros con anticuerpos dirigidos contra HCV por ELISA, de los cuales 8 fueron confirmados por RIBA ( 1.03 por ciento de la población total analizada). Dos sueros positivos mostraron bandas de reactividad intensa y 6 dieron bandas de reactividad débil. Los 4 sueros negativos representan el 0.5 por ciento de falsos positivos de la prueba de ELISA para determinar anti-HCV. Conclusiones: En este estudio se encontró que la frecuencia de anticuerpos anti-HCV fue 7.95 veces más alta que la de HBs-Ag. Todos los sujetos seropositivos estaban asintomáticos, pero son considerados potencialmente infectantes. Este trabajo pone de manifiesto la necesidad de implantar en forma rutinaria las técnicas de detección de HBs-Ag y de los anticuerpos anti HCV, para poder establecer la prevalencia de estas enfermedades virales en nuestra región.

Prevalence of hepatitic C virus antibodies in chronic liver disease, hepatitis, hepatocellular carcinoma and rheumatoid arthritis

The prevalence of antibodies to hepatitis C virus [Anti-HCV] has been measured using HCV EIA 2 second generation test in 97 patients with chronic liver disease [CLD], hepatitis, hepatocellular carcinoma [HCC] and rheumatoid arthritis [RA]. 45 normal subjects served as control. 46.15% of 39 patients with CLD were positive for anti-HCV, while 64.7% of 17 patients with hepatitis showed positive antibodies to HCV. In HCC, 60% of 15 patients were positive to anti-HCV. Interestingly, 36.4% of 26 patients with RA having positive rheumatoid factor showed positive antibodies to HCV and 11.1% of normal controls were positive to anti-HCV. HBsAg was positive in 20.5% in CLD and in 47% in hepatitis group, while 40% of HCC patients showed positive HBsAg. Low prevalence of HBsAg was found in RA and controls [3.8% and 4.4% respectively]. Our study revealed that HCV has a role in causation of hepatitis, hepatocellular carcinoma and chronic liver disease in our locality. Also, cross-reactivity between antibodies to HCV and other antibodies [rheumatoid factors] may occur

Prevalence of hepatitis E among patients with acute hepatitis

This study included 361 patients who were admitted with clinical manifestations and laboratory results of acute virus hepatitis. It was carried out in King Faisal Hospital, Makkah, the only center for infectious disease there. The results revealed that the hepatitis A is the most common cause of acute hepatitis [74.5%], and the male were affected more than females [56.5%, 43.5%]. Both acute hepatitis and hepatitis E have high prevalence rate below the age of 12 years. Hepatitis E virus plays a minor role [11.3%] as a cause of acute hepatitis in Makkah and most of the cases were coming from low standard area where poor sanitary disposal of excreta. So, improvement in water supplies, sewage disposal and hygiene should be effective in lowering HEV incidence

Delta virus versus HBsAg in chronic active hepatitis and their relation to clinical, laboratory, and morbidity findings in bilharzial and non-bilharzial patients

This work was done to study the effect of delta virus and HBV infection, as two etiological factors on clinical presentation, biochemical liver functions and prognosis of chronic active hepatitis [CAH] in schistosomiasis infected and non-infected patients. 66.7% of the patients were carriers for HBsAg, among them 41.7% were infected with delta virus. It was evident that the clinical presentation of the patients with positive serological markers of HBV and HDV demonstrated advancing liver disease than in the other studied groups. Moreover, the biochemical liver profile was significantly affected when the triad of chronic HBV, delta virus and schistosomiasis infection was present. This could be related to the immunosuppression caused by schistosomal infection. Furthermore, mortality rate was significantly higher in schistosomiasis infected individuals