Assuntos
Anticorpos Monoclonais Humanizados , Toxidermias , Psoríase , Humanos , Anticorpos Monoclonais Humanizados/efeitos adversos , Toxidermias/etiologia , Toxidermias/patologia , Psoríase/tratamento farmacológico , Psoríase/induzido quimicamente , Psoríase/patologia , Antineoplásicos Imunológicos/efeitos adversos , Exantema/induzido quimicamente , Exantema/patologia , Masculino , Feminino , IdosoRESUMO
The monkeypox virus (MPXV) outbreak, primarily endemic to Africa, has spread globally, with Brazil reporting the second-highest number of cases. The emergence of MPXV in non-endemic areas has raised concerns, particularly due to the co-circulation of other exanthematous viruses such as varicella-zoster virus (VZV) and molluscum contagiosum virus (MOCV). To perform an accurate differential diagnosis of MPXV during the ongoing outbreak in Minas Gerais, Brazil, a 5PLEX qPCR assay targeting orthopoxviruses (OPV), VZV, and MOCV was used to retrospectively analyze all clinical samples that tested negative for MPXV in the initial screening conducted at Funed. In summary, our study analyzed 1,175 clinical samples received from patients suspected of MPXV infection and found a positivity rate of 33.8% (397 samples) for MPXV using the non-variola qPCR assay. Testing the 778 MPXV-negative clinical samples using the 5PLEX qPCR assay revealed that 174 clinical samples (22.36%) tested positive for VZV. MOCV DNA was detected in 13 and other OPV in 3 clinical samples. The sequencing of randomly selected amplified clinical samples confirmed the initial molecular diagnosis. Analysis of patient profiles revealed a significant difference in the median age between groups testing positive for MPXV and VZV and a male predominance in MPXV cases. The geographic distribution of positive cases was concentrated in the most populous mesoregions of Minas Gerais state. This study highlights the challenges posed by emerging infectious diseases. It emphasizes the importance of epidemiological surveillance and accurate diagnosis in enabling timely responses for public health policies and appropriate medical care. IMPORTANCE: Brazil ranks second in the number of cases during the global monkeypox epidemic. The study, conducted in Minas Gerais, the second most populous state in Brazil with over 20 million inhabitants, utilized differential diagnostics, revealing a significant number of positive cases for other exanthematous viruses and emphasizing the need for accurate diagnoses. During the study, we were able to assess the co-circulation of other viruses alongside monkeypox, including varicella-zoster virus, molluscum contagiosum virus, and other orthopoxviruses. The significance of the research is underscored by the concentration of positive cases in populous areas, highlighting the challenges posed by emerging infectious diseases. This demographic context further amplifies the importance of the research in guiding public health policies and medical interventions, given the substantial population at risk. The study not only addresses a global concern but also holds critical implications for a state with such a large population and geographic expanse within Brazil. Overall, the study emphasizes the pivotal role of surveillance and precise diagnosis in guiding effective public health responses and ensuring appropriate medical interventions.
Assuntos
Surtos de Doenças , Humanos , Brasil/epidemiologia , Estudos Retrospectivos , Masculino , Feminino , Adulto , Diagnóstico Diferencial , Criança , Adolescente , Mpox/diagnóstico , Mpox/epidemiologia , Mpox/virologia , Adulto Jovem , Pré-Escolar , Pessoa de Meia-Idade , Monkeypox virus/genética , Monkeypox virus/isolamento & purificação , Herpesvirus Humano 3/genética , Herpesvirus Humano 3/isolamento & purificação , Lactente , Idoso , Exantema/virologia , Exantema/epidemiologia , Reação em Cadeia da Polimerase em Tempo RealRESUMO
Se presenta un caso femenino de dengue clásico (DC) en el marco de la epidemia 2023-2024 en la provincia de Misiones, con predominio de síntomas dermatológicos de exantemas máculo papulosos, habonosos y eritrodérmicos sobre los síntomas sindrómicos cardinales. Las lesiones presentan componente humoral y de extravasación, sin diátesis ni componentes purpúricos apreciables, presentando una rápida y efectiva evolución al eritema y la normalización con tratamiento antihistamínico y corticoide parenteral. De la misma manera se evalúan alteraciones analíticas hematológicas y hepáticas de gran magnitud, con escasa repercusión clínica, que se mensuran en función del riesgo relativo al dengue hemorrágico (DH) y el pronóstico de la paciente. (AU)
A female case of classic dengue (DC) is presented in the context of the 2023-2024 epidemic in the province of Misiones, with a predominance of dermatologic symptoms of maculopapular, hives, and erythrodermic rashes overlapping the cardinal syndromic symptoms. The lesions have a humoral and extravasation component, without any significant diathesis or purpuric components, showing rapid and effective progression to erythema and normalization with antihistamine and parenteral corticosteroid treatment. Similarly, hematologic and hepatic analytical alterations of great magnitude are evaluated, with little clinical impact, measured in terms of relative risk for hemorrhagic dengue (HD) and the prognosis of the patient. (AU)
Assuntos
Humanos , Feminino , Adulto , Dengue/complicações , Dengue/diagnóstico , Exantema/diagnóstico , Exantema/etiologia , Argentina , Betametasona/uso terapêutico , Cetirizina/uso terapêutico , Dengue/terapia , Diagnóstico Diferencial , Exantema/tratamento farmacológico , Acetaminofen/uso terapêuticoRESUMO
INTRODUCTION: The outbreak of monkeypox occurred in 2022 and led to a fast spread of the disease worldwide. The goal of this study is to describe the epidemiological, clinical, virological and evolving characteristics of the disorder. METHODS: We conducted a retrospective, observational and analytical study between July and October, 2022, in a Dermatology Unit. RESULTS: 124 subjects were included. Mean age was 31.5 years, 123 (99.2%) were men and 75 (60.5%) were HIV positive. The main transmission route was sexual and the incubation period was 7 days. The onset of the rash were the genitalia and perianal region in 74.2% of cases, and median time elapsed until the last scab fell off was 16 days. All patients developed a vesicular rash and 86.3% of them had systemic symptoms. Disease was moderate in 68.5% of patients and complications occurred most often when systemic symptoms and/or disseminated skin disease were present. Proctitis was the most frequent complication (59.4%) and its greater incidence was seen in the population with HIV. No significant difference was observed in real-time PCR cycle threshold values with regards to type of sample or duration of disease. Survival rate was 99.2% and other concomitant sexually transmitted infections were detected in 33.8% of patients. DISCUSSION: It is important to suspect the disease in subjects with high-risk sexual practices and a consistent clinical presentation. Swab samples of lesions as well as of scabs have proven useful for the diagnosis.
Introducción: El brote de viruela símica 2022 se extendió rápidamente por todo el mundo. El objetivo del presente trabajo es describir las características epidemiológicas, clínicas, evolutivas y virológicas. Métodos: Estudio retrospectivo, observacional y analítico entre julio-octubre del 2022 en pacientes atendidos en una Unidad de Dermatología. Resultados: Se incluyeron 124 individuos. La mediana de edad fue de 31.5 años, siendo 123 (99.2%) hombres y 70 (60.5%) HIV positivos. La vía principal de contagio fue la transmisión sexual y el período de incubación de 7 días. Las lesiones se iniciaron en la región genital y perianal en el 74.2% de los casos y el tiempo hasta la caída de la última costra presentó una mediana de 16 días. Todos desarrollaron exantema vesiculoso, el 86.3% de los individuos presentó síntomas sistémicos. La enfermedad fue moderada en el 68.5% de los pacientes y las complicaciones se observaron con mayor frecuencia en aquellos con síntomas sistémicos y/o enfermedad diseminada. Proctitis fue la complicación más destacada (59.4%) y su mayor incidencia se observó en la población con HIV. No hubo diferencias significativas en los valores de Ct de la qPCR al evaluar tipo de muestra procesada o tiempo de evolución de la enfermedad. La sobrevida fue del 99.2% y en el 33.8% de los pacientes se detectaron otras infecciones concomitantes de transmisión sexual. Discusión: Se debe sospechar la enfermedad en individuos con cuadro compatible y prácticas sexuales de riesgo. Las muestras de hisopado de lesiones y de costra resultaron útiles para el diagnóstico.
Assuntos
Exantema , Mpox , Proctite , Masculino , Humanos , Adulto , Feminino , Estudos Retrospectivos , Surtos de Doenças , Exantema/epidemiologiaAssuntos
Artrite , Exantema , Humanos , Artrite/complicações , Síndrome , Febre/etiologia , Exantema/etiologiaRESUMO
Few reports describing an association between UV radiation and fixed skin eruptions have been published since 1975. These reactions have received various names, including fixed sunlight eruption, fixed exanthema due to UV radiation, and broad-spectrum abnormal localized photosensitivity syndrome. We present a series of 13 patients (4 men [30.8%] and 9 women [69.2%]) aged between 28 and 56 years who were evaluated for fixed eruptions induced by UV radiation at a dermatology referral hospital in Bogotá, Colombia. The lesions were located on the inner thighs, buttocks, popliteal region, anterior and posterior axilla, and dorsum of the feet. Photoprovocation reproduced lesions in all the affected areas, and histopathology showed changes similar to those seen in fixed drug eruptions. While these UV-provoked reactions may be a type of fixed skin eruption, we cannot rule out that they may also be a distinct condition that simply shares a pathogenic mechanism with fixed eruptions.
Assuntos
Exantema , Transtornos de Fotossensibilidade , Masculino , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Colômbia/epidemiologia , Luz Solar/efeitos adversos , Transtornos de Fotossensibilidade/etiologia , Transtornos de Fotossensibilidade/patologia , Raios Ultravioleta/efeitos adversos , Exantema/etiologiaRESUMO
BACKGROUND Cutaneous adverse drug reactions are the skin's response to a systemic exposure to drugs. Linezolid is an oral oxazolidine used to treat methicillin-resistant Staphylococcus aureus infections. Even though it has well-known adverse effects, purpuric cutaneous adverse drug reactions to linezolid have been scarcely described. This report is of a Puerto Rican man in his 80s who developed an extensive purpuric drug eruption secondary to linezolid use. Clinicians should be aware of this phenomenon, since prompt identification and discontinuation of the agent are essential for recovery. CASE REPORT An 89-year-old Puerto Rican man was given oral linezolid therapy for healthcare-associated pneumonia and developed a widespread, purpuric cutaneous eruption 5 days into therapy. His condition prompted immediate discontinuation of the drug. Forty-eight hours after stopping the medication, he visited the Emergency Department. Abdominal punch biopsy revealed a superficial and perivascular lymphocytic infiltrate with dermal eosinophils, a pathologic finding consistent with a purpuric drug eruption. This allowed for a timely diagnosis, exclusion of other mimickers, such as cutaneous vasculitis, and effective management. CONCLUSIONS Cutaneous adverse drug reactions to linezolid have been scarcely reported in the literature. Due to the low incidence of this manifestation, the identification of the causative agent and accompanying treatment may be delayed. Mainstays in therapy are avoidance of the offending agent and treatment with corticosteroids, antihistamines, barrier ointments, and oral analgesics. Primary healthcare providers should be aware of linezolid-induced cutaneous manifestations, diagnostic clues, and treatment options so they can rapidly identify and effectively treat such complications.
Assuntos
Toxidermias , Exantema , Staphylococcus aureus Resistente à Meticilina , Púrpura , Vasculite , Masculino , Humanos , Idoso de 80 Anos ou mais , Linezolida/efeitos adversos , Púrpura/induzido quimicamente , Púrpura/complicações , Púrpura/patologia , Toxidermias/diagnóstico , Toxidermias/etiologia , Toxidermias/patologia , Vasculite/complicaçõesRESUMO
The bacille Calmette-Guérin (BCG) vaccine is administered in many countries as part of their vaccination schedules. Epidemiologic studies have suggested a possible benefit of this vaccine in the context of the COVID-19 pandemic and other respiratory infections. We aimed to assess the safety of this intervention in BCG-primed adults. Adult health care workers (n = 451) received a single intradermal application of the BCG vaccine (Tokyo 172 strain) in the deltoid region of the right arm. Follow-up (30 days) calls and clinical inspections were guided using a standardized data sheet to assess local and systemic reactions. Early local reactions were common at 24 h and 7 days, such as erythema (74.9%, 69.2%), induration (55.7%, 59%), a papule (53.4%, 47.7%), and edema (48.3%, 38.1). Local symptoms (pruritus 44.8%, heat 16.2%, and pain 34.8%) were less frequent at day 7. Late expected reactions (14 and 30 days) included the formation of crusts (39.6% and 63.9%), a pustule (36.6% and 17%), or ulcers (28.8% and 17.7%). Severe reactions were limited to subcutaneous abscesses (2%) and lymphadenitis (<1%).