Caracterização clínica das síndromes neurológicas durante a tríplice epidemia de arboviroses em Salvador, Bahia, Brasil / Clinical characterization of neurological syndromes during the triple arbovirus epidemic in Salvador, Bahia, Brazil

INTRODUÇÃO: Os arbovírus são vírus transmitidos por vetores artrópodes e diversos deles podem ser encontrados em cocirculação no Brasil. Complicações neurológicas associadas aos vírus dengue (DENV), chikungunya (CHIKV) e zika (ZIKV) já foram descritas anteriormente na literatura. Durante a tríplice epidemia de arboviroses houve um aumento importante de casos neurológicos, principalmente síndrome de Guillain-Barré (GBS).MATERIAL E MÉTODOS: Iniciada uma vigilância hospitalar para síndromes neurológicas agudas, onde foram incluídos pacientes avaliados em unidades neurológicas de dois hospitais de referência em Salvador/BA durante o período de maio de 2015 a abril de 2016.RESULTADOS: Cinco artigos foram escritos para melhor caracterização do tema. Dois casos de GBS clássico associado ao ZIKV foram publicados durante o surto supracitado, sendo um dos primeiros artigos no Brasil relacionando as duas doenças. Foi realizada a descrição com detalhes o caso da rara síndrome opsoclonus-mioclonusencefalite (OMAS), no qual a pacientes e apresentara com alteração de sensório, movimentos oculares anárquicos e ataxia. Na investigação foram detectados o DENV e CHIKV no plasma e o CHIKV no líquor pelo RTPCR.A paciente foi tratada com corticoide venoso e teve alta com melhora funcional, semalterações cognitivas ou motoras. Uma série de 5 casos descreveu com mais detalhe uma forma neurológica mais leve, a polineuropatia sensitiva reversível (RSP). Todos os pacientes apresentaram quadros transitórios, exclusivamente de alterações sensitivas; dois casos tinham evidência de infecção recente por ZIKV e outros 2 por CHIKV. Uma série de casos de pacientes com GBS, avaliou 14 indivíduos, sendo que 50% destes apresentavam variantes dessa doença. Havia uma maior prevalência de acometimento do nervo facial do que nas populações previamente estudadas. Prevaleceu a forma desmielinizante na eletroneuromiografia desses pacientes. Setenta e dois por cento dos pacientes foram reavaliados em 30 dias e todos tiveram ótima recuperação funcional. Por fim foi escrito um estudo de corte transversal que descreveu as síndromes neurológicas ocorridas em Salvador durante o surto da tríplice arboviral com 29 pacientes acompanhados; aproximadamente 50% se apresentaram com GBS ou suas variantes. Outras manifestações como encefalites, mielites, OMAS e RSP foram descritas. Cerca de 80% dos pacientes apresentavam evidência sorológica de infecção recente por ZIKV ou CHIKV. CONCLUSÃO: Foram descritas manifestações neurológicas como GBS e outras síndromes relacionadas às arboviroses. O melhor conhecimento dessas manifestações pode trazer benefício para prevenção, diagnóstico e tratamento dessas doenças, assim como melhorar as ações em saúde pública para combate às complicações por arboviroses

INTODUCTION: Arboviruses are viruses transmitted by arthropod vectors and several ofthem can be found in cocirculation in Brazil. Neurological complications associated with dengue virus (DENV), chikungunya (CHIKV) and zika (ZIKV) have previously been described in the literature. During the triple epidemic of arboviruses there was a significant increase in neurological cases, mainly Guillain-Barré syndrome (GBS). MATERIAL AND METHODS: A hospital surveillance for acute neurological syndromes was started, which included patients evaluated in neurological units of two reference hospitals in Salvador / BA during the period from May 2015 to April 2016. RESULTS: Five articles were written to better characterize the clinical manifestations. Two cases of classic GBS associated with ZIKV were published during triple arbovirosis outbreak, being one of the first articles in Brazil correlating the two diseases. A detailed description was made of the rare opsoclonus-myoclonus encephalitis syndrome (OMAS), in another article, in which the patient presented with confusion, anarchical ocular movements and ataxia. DENV and CHIKV were detected in plasma and CHIKV in the CSF by RT-PCR. The patient was treated with venous corticosteroids and was discharged with functional improvement, without cognitive or motor alterations. A series of 5 cases described a milder neurological form, the reversible sensory polyneuropathy (RSP). All patients presented only with transient sensory disturbances; two cases evidenced recent infection by ZIKV and another 2 by CHIKV. A case-series of GBS patients evaluated 14 individuals, with 50% of them presenting with GBS subtypes. There was a higher prevalence of facial nerve involvement than in the previously studied populations. The demyelinating form prevailed in the electroneuromyography studies of these patients. Seventy-two percent of the patients were reassessed in 30 days and all had an optimal functional recovery. Finally, a cross-sectional study was written and described the neurological syndromes that occurred in Salvador during the outbreak of the triple arboviral with 29 patients followed up; approximately 50% presented with GBS or its subtypes. Other manifestations such as encephalitis, myelitis, OMAS and RSP were described. About 80% of the patients had serological evidence of recent infection by ZIKV or CHIKV. CONCLUSION: Neurological manifestations such as GBS and other syndromes related to arbovirus have been described. The better knowledge of these manifestations can benefit the prevention, diagnosis and treatment of these diseases, as well as to improve the actions in public health to combat complications by arbovirosis

Chikungunya outbreak in Pakistan

During the month of February 2017, Pakistan's Ministry of National Health Services, Regulations and Coordination reported new cases of Chikungunya. Since December 2016 up to 24 February 2017, a total of 816 cases have been reported in the Sindh province, including 29 cases reported from various towns in Karachi

La explosión del virus de sika / The explosion of zika virus / A explosão do vírus do zika

El siguiente informe aborda la historia de los primeros casos de Zika, su disperción y complicaciones. Aborda también los rasgos diferenciales entre zika, dengue y chikungunya. Luchacontra el vector y vacuna contra el dengue.

The following report deals with the story of the first cases of Zika, their dispersal and complications. also discusses the distinguishing features between zika, dengue and chikungunya. Fight vector and dengue vaccine.

O relatório a seguir lida com a história dos primeiros casos de Zika, sua dispersão e complicações. também discute as características distintivas entre Zika, dengue e chikungunya. lutavetor ea dengue vacina.

Manifestaciones mucocutáneas de la fiebre chikungunya / Mucocutaneous manífestatíons of chíkungunya fever

La fiebre chikungunya (FC) es una enfermedad vírica trasmitida por Aedes aegypti y Aedes albopictus infectados. El virus chikungunya es un ARN virus perteneciente a la género Alphavirus de la familia Togaviridae. La FC manifiesta una tendencia epidémica secuelar, cíclica y estacional. El ciclo natural del virus es humano-mosquito-humano. Actualmente la trasmisión autóctona se ha registrado en 36 países/territorios de la región de las Américas, en República Dominicana (64,7 %), Guadalupe (10,5 %), Martinica (8,8 %) Y Haití (8,5 %) los que han reportado el mayor número de casos y defunciones por fiebre. En Perú, actualmente no se ha reportado transmisión autóctona de FC. El virus chikungunya causa una enfermedad febril en la mayoría de los pacientes, con un período de incubación de 2 a 4 días a partir de la mordida del mosquito. La viremia persiste por 5 días desde el inicio de los síntomas. Las manifestaciones más comunes son fiebre (92 %), artralgia (87 %), dorsalgia (67 %), y cefalea (62 %). Algunas de estas enfermedades consideradas como diagnóstico diferencial son la leptospirosis, el dengue, la malaria, la meningitis y la fiebre reumática. Las manifestaciones cutáneas ocurrieron en aproximadamente 77 % de los casos, la mayoría de ellos presenta un exantema generalizado que consiste en máculas o pápulas no coalescentes, hiperpigmentaclán, xerosis, úlceras genitales. Hay ciertas diferencias en la presentación de la FC en niños y adultos. Mientras que en niños los cambios pigmentarios son generalizados, en adultos se presenta la forma centrofacial o pigmentación melasma like. Existen reportes de empeoramiento de lesiones de psoriasis o dermatitis atópica requieren manejo específico por parte del dermatólogo.

Chikungunya fever is a viral disease transmitted by infected Aedes aegypti and A. albopictus. The virus name (CHIK) is an RNA virus belonging to the genus Alphavirus of the Togaviridae family. Chikungunya fever manifests seque lar, cyclical and seasonal epidemic trend. The natural cycle of the virus is human-mosquito-human. Currently the autochthonous transmission is registe red in 36 countries / territories in the region of the Americas; being Dominican Republic (64,7 %), Guadeloupe (10,5 %), Martinique (8,8 %) and Haiti (8,5 %) where were reported the highest number of cases and deaths from chikungunya fever. Autocluhonous transmission of chikungunya fever currently has not been reported in Peru. The CH1K fever virus causes disease in most patients, with an incubation period of 2-4 days after the bite of the mosquito. The viremia persists for 5 days from the onset of symptoms. The most common manifestations are fever (92 %), arthralgia (87 %), back pain (67 %), and headache (62 %). Some of these diseases are considered as a differential diagnosis: leptospirosis, dengue, malaria, meningitis, rheumatic fever. Cutaneous manifestations occur in approximately 77 % of cases, most of them presents a generalized rash consisting of macules or papules coalescing, hyperpigmentation, xerosis, genital ulcers. There are certain differences in the presentation of chikungunya fever in children and adults. While children are widespread pigmentary changes in the midface adult form or pigmentation like melasma occurs. There are reports of worsening psoriasis lesions or atopic dermatitis require specific handling by the dermatologist.

[Foro de opinión] - Fiebre chikungunya / Fever chikungunya

La fiebre chikungunya (en idioma makonde: chikungunya,que significa hombre doblado o retorcido), conocida tambiéncomo artritis epidémica chikungunya. Es producida por unvirus ARN del género alfavirus, familia Togaviridae, el cuales transmitido por dos especies de mosquitos: Aedes aegyptiy Aedes albopictus.

Chikungunya (in Makonde Language: chikungunya,which means man bent or twisted), also knownas chikungunya epidemic arthritis. It is produced by aalphavirus RNA virus genus, family Togaviridae, whichIt is transmitted by two species of mosquito: Aedes aegyptiand Aedes albopictus.