ABSTRACT
PURPOSE OF REVIEW: In recent years some extensive and alarming outbreaks of disease caused by alphaviruses, including arthralgia or even severe and long-lasting arthritis have taken place. Therefore, awareness of this possibility should be increased. RECENT FINDINGS: Studies on the epidemiology of alphaviruses, especially regarding Ross River, Chikungunya and pogosta disease have been carried out. They appear to have spread into new geographic areas. The biological cycle of these viruses involves vertebrate hosts and arthropod vectors, of which mosquitoes are the most important and pass the infection to humans. It is apparent that not only changes in the climate but also increasing travel and trade, and urbanization favour the spread of both alphaviruses and of mosquitoes. Clinical studies have confirmed that arthritis, which is a part of the disease entity, may be quite severe and long lasting. The need of better control of mosquitoes and proper control measures against them is pointed out. SUMMARY: The most important alphaviruses causing joint inflammation, the clinical picture of the diseases and their epidemiological features are described. Arthritis caused by alphaviruses is certainly increasing and it should be kept in mind as a possibility especially in those cases where the disease starts with flulike symptoms, and rash is involved.
Subject(s)
Alphavirus Infections/complications , Arthritis/virology , Arthropod Vectors , Alphavirus Infections/epidemiology , Animals , Humans , PrevalenceABSTRACT
This review is concentrated on specifically diagnosable viral diseases causing recent onset polyarthritis. A suspicion of viral etiology of arthritis should arise when there are symptoms of infection such as fever, skin manifestations, neurologic signs, or when several cases are occurring at the same time, suggesting an outbreak. In addition to the history and clinical examination, serology is a key element in the diagnosis. Some of these infections are known to occur at certain geographic areas, and the local clinicians are aware of this possibility. HIV and HCV infections occur worldwide, and they should be kept in mind when treating patients with recent-onset arthritis.
Subject(s)
Arthritis/virology , Alphavirus/isolation & purification , Hepatitis Viruses/isolation & purification , Humans , Time FactorsABSTRACT
A 42-year-old woman developed a rapidly progressing fatal heart failure. At the autopsy extensive necrosis of the myocardium was seen, with an almost complete absence of inflammatory cells and the presence of bacterial structures identified as Staphylococcus lugdunensis by PCR. In addition, the cytomegalovirus genome was found to be located inside the cardiomyocytes.
Subject(s)
CREST Syndrome/complications , Cytomegalovirus/isolation & purification , Myocarditis/microbiology , Myocarditis/virology , Staphylococcus/isolation & purification , Adult , Cytomegalovirus Infections/microbiology , Fatal Outcome , Female , Humans , Muscle Cells/microbiology , Muscle Cells/virology , Myocardium/pathology , Necrosis , Staphylococcal Infections/microbiologyABSTRACT
Reactive arthritis is an infectious disease which may be initiated by several microbes in genetically susceptible hosts. The best known predisposing genetic factor is HLA-B27, but the mechanisms behind its action are still elusive. Worldwide agreement exists regarding the general guidelines in the diagnosis, differential diagnosis and management, even though official diagnostic criteria are not yet available. Several studies indicate that antibiotics are effective only if started before the immunological mechanisms of pathogenesis have been turned on. However, recent observations suggest that a 3-month course of antibiotics may diminish the late risk of chronic sequelae, especially in HLA-B27-positive patients with reactive arthritis.
