Posts filed under ‘FIEBRE y RASH’

Skin Manifestations of COVID-19

Cleveland Clinic Journal of Medicine May 14, 2020

Las manifestaciones cutáneas, un efecto bien conocido de las infecciones virales, comienzan a notificarse en pacientes con COVID-19.

Estas manifestaciones con mayor frecuencia son:

erupción morbiliforme,

urticaria,

erupciones vesiculares,

lesiones acrales y

erupciones livedoides.

Algunas de estas manifestaciones cutáneas surgen antes de los signos y síntomas más comúnmente asociados con COVID-19, lo que sugiere que podrían estar presentando signos de COVID-19.

Es bien sabido que las manifestaciones cutáneas se producen en el contexto de enfermedades virales y, en ocasiones, estas manifestaciones tienen valor diagnóstico o pronóstico.

Con COVID-19, aunque estamos en un punto relativamente temprano de la pandemia, comienzan a surgir manifestaciones cutáneas en pacientes infectados de todo el mundo.

En este artículo, describen algunas de las anormalidades cutáneas actuales observadas en pacientes con COVID-19.

PDF

https://www.ccjm.org/content/ccjom/early/2020/05/12/ccjm.87a.ccc031.full.pdf

May 22, 2020 at 5:04 pm

REVIEW – Cutaneous Manifestations of COVID-19: Report of Three Cases and a Review of Literature

J Dermatol Sci April 29, 2020

Se han observado diversas manifestaciones cutáneas en pacientes con infección por COVID-19. Sin embargo, las similitudes generales en la presentación clínica de estas manifestaciones dermatológicas aún no se han resumido.

Esta revisión tiene como objetivo proporcionar una visión general de diversas manifestaciones cutáneas en pacientes con COVID-19 a través de tres informes de casos y una revisión de la literatura.

Realizaron una búsqueda bibliográfica utilizando los motores de búsqueda PubMed, OVID y Google para artículos originales y de revisión. Se incluyeron estudios escritos en inglés que mencionaban síntomas cutáneos y COVID-19.

Resultados

18 artículos y 3 casos adicionales informados en este documento se incluyeron en esta revisión.

De estos estudios, 6 son series de casos y 12 son estudios de informes de casos.

La manifestación cutánea más común de COVID-19 fue el exantema maculopapular (morbiliforme), que se presentó en el 36,1% (26/72) pacientes.

Las otras manifestaciones cutáneas incluyeron:

erupción papulovesicular (34.7%, 25/72),

urticaria (9.7%, 7/72),

pápulas dolorosas de color rojo púrpura acral (15.3%, 11/72) de pacientes,

lesiones de livedo reticular (2.8% , 2/72) y

petequias (1,4%, 1/72).

La mayoría de las lesiones se localizaron en el tronco (66,7%, 50/72), sin embargo, el 19,4% (14/72) de los pacientes experimentaron manifestaciones cutáneas en las manos y los pies.

El desarrollo de la lesión cutánea ocurrió antes del inicio de los síntomas respiratorios o el diagnóstico de COVID-19 en el 12.5% (9/72) de los pacientes, y las lesiones se curaron espontáneamente en todos los pacientes dentro de los 10 días.

La mayoría de los estudios no informaron correlación entre la gravedad de COVID-19 y las lesiones cutáneas.

Conclusión

La infección con COVID-19 puede dar lugar a manifestaciones dermatológicas con diversas presentaciones clínicas, lo que puede ayudar en el diagnóstico oportuno de esta infección.

FULL TEXT

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7189855/

May 22, 2020 at 5:02 pm

Letter – COVID-19 can present with a rash and be mistaken for Dengue.

Journal of the American Academy of Dermatology  March 22, 2020 

Joob B1, Wiwanitkit V2.

Author information

1 Sanitation1 Medical Academic Center, Bangkok Thailand. Electronic address: beuyjoob@hotmail.com.

2 Honorary professor, dr DY Patil University, Pune, India; visiting professor, Hainan Medical University, Haikou, China.

Carta al Editor: Nos gustaría compartir nuestra experiencia de Tailandia, el 2do país en el que se produjo la infección COVID-19 desde principios de enero de 2020 [2].

Al 5/marzo/20, hay 48 casos acumulados de COVID-19 en Tailandia. Entre estos 48 casos, hubo un caso interesante que se presentó con un rash cutáneo con petequias.

Debido a que el dengue es muy común en nuestra región y la erupción petequial es un hallazgo clínico común en el dengue y el paciente tenía un recuento bajo de plaquetas, el 1er médico a cargo hizo diagnóstico clínico de dengue.

No hubo fotografía y la biopsia no es una práctica de rutina según la guía de práctica clínica del dengue en nuestro región tropical. De modo que el caso fue inicialmente diagnosticado erróneamente como dengue, lo que resultó en un diagnóstico tardío [3].

En este caso, el paciente posteriormente presentó problemas respiratorios y fue remitido a otro centro médico donde descartaron otras infecciones virales comunes que pueden causar fiebre, rash cutáneo y trastornos  respiratorios. Investigaciones posteriores y la rt-PCR concluyeron que se trataba de infección por COVID-19.

Existe la posibilidad de que un paciente con COVID-19 presente inicialmente un rash cutáneo que puede diagnosticarse erróneamente como otra enfermedad común. Además, algunos de estos pacientes se presentan inicialmente afebriles [4].

Creemos que el médico debe tener presente la posibilidad de que el paciente solo tenga una erupción cutánea y pensar en COVID-19 para prevenir la transmisión.

PDF

https://www.jaad.org/article/S0190-9622(20)30454-0/pdf

 

 

April 2, 2020 at 8:52 pm

REVIEW – Human papillomavirus in 2019: An update on cervical cancer prevention and screening guidelines

Cleveland Clinic Journal of Medicine December 2019 V.86 N.12 P.173-178

ABSTRACT

The human papillomavirus (HPV) causes most cases of cervical cancer. Healthcare providers can help prevent this cancer by recommending HPV vaccination when appropriate, regularly screening women for cervical cancer, and following up on abnormal test results.

KEY POINTS

-Immunization against HPV can prevent up to 70% of HPV-related cervical cancer cases.

-Gardasil 9 is the only HPV vaccine currently available in the United States and is now approved for use in males and females between the ages of 9 and 45.

-In girls and boys younger than 15, a 2-dose schedule is recommended; patients ages 15 through 45 require 3 doses.

-Vaccine acceptance rates are highest when primary care providers announce that the vaccine is due rather than invite open-ended discussions.

-Regular cervical cancer screening is an important preventive tool and should be performed using the Papanicolaou (Pap) test, the high-risk HPV-only test, or the Pap-HPV cotest.

FULL TEXT

https://www.ccjm.org/content/86/3/173

PDF

https://www.ccjm.org/sites/default/files/additional-assets/PDFs/86_3_173.pdf

January 20, 2020 at 10:54 am

EDITORIAL – The return of measles—an unnecessary sequel

Cleveland Clinic Journal of Medicine December 2019 V.86 N.12 P.365-366

Concerns over fake news and alternative facts have permeated the fabric of our daily life. Trust in entrenched establishments seems to be at an all-time low. I grew up in the 1960s; I grew up with “don’t trust the man.” I grew up with the Vietnam War, Watergate, and the military-industrial complex, and I have read and heard enough since then to know that a good amount of our distrust was well founded. More recently, there has been increased public scrutiny of the “pharmaceutical-medical complex,” with concerns being raised in the media and by legislators regarding drug pricing, seemingly inappropriate physician prescribing of medications encouraged by drug manufacturers, and the overall costs of medical care. And yes, there is …

FULL TEXT

https://www.ccjm.org/content/86/6/365

PDF

https://www.ccjm.org/content/ccjom/86/6/365.full.pdf

January 20, 2020 at 10:52 am

Review – Measles: A dangerous vaccine-preventable disease returns

Cleveland Clinic Journal of Medicine December 2019 V.86 N.12 P.393-398

ABSTRACT

Although a safe and effective vaccine has been available for over 6 decades, vaccine hesitancy in the United States and social and political unrest globally have led to under-vaccination. As a result, in recent months, vaccine control of measles has been threatened with an alarming upswing in measles cases nationally and internationally. Here, we review the disease and its management in view of recent outbreaks.

KEY POINTS

-Measles is highly contagious and can have serious complications, including death.

-Measles vaccine is given in a 2-dose series. People who have received only 1 dose should receive either 1 or 2 more doses, depending on the situation, so that they are protected.

-The diagnosis of measles is straightforward when classic signs and symptoms are present—fever, cough, conjunctivitis, runny nose, and rash—especially after a known exposure or in the setting of outbreak. On the other hand, in partially vaccinated or immunosuppressed people, the illness presents atypically, and confirmation of diagnosis requires laboratory testing.

-Management is mostly supportive. Children—and probably also adults—should receive vitamin A.

-Since disease can be severe in the unvaccinated, immune globulin and vaccine are given to the normal host with an exposure and no history of vaccine or immunity.

FULL TEXT

https://www.ccjm.org/content/86/6/393

PDF

https://www.ccjm.org/sites/default/files/additional-assets/PDFs/86_6_393.pdf

January 20, 2020 at 10:50 am

SARAMPION – NUEVAS RECOMENDACIONES DE VACUNACIÓN PARA SU CONTROL.

ALERTA EPIDEMIOLÓGICA – 02 de enero de 2020 – SE 1

BROTE DE SARAMPIÓN EN CURSO

NUEVAS RECOMENDACIONES DE VACUNACIÓN PARA SU CONTROL.

Ante la continua detección de nuevos casos de sarampión en la Ciudad Autónoma de Buenos Aires (CABA) y municipios del área metropolitana de la provincia de Buenos Aires asociado a proximidad de las vacaciones de verano y la alta movilidad poblacional hacia zonas turística, con el consiguiente riesgo de diseminación de casos de sarampión en otras jurisdicciones, el Ministerio de Salud de la Nación, en consenso con las jurisdicciones y las comisiones asesoras, recomienda continuar con las medidas de contención de brote en curso y decide actualizar las indicaciones de vacunación a viajeros hacia zonas con circulación viral activa…..

PDF

https://www.argentina.gob.ar/sites/default/files/alerta_31-12-19_version_final.pdf

January 4, 2020 at 7:47 am

Efficacy of a Tetravalent Dengue Vaccine in Healthy Children and Adolescents

NEJM November 21, 219 V.381 P.2009-2019

Shibadas Biswal, M.D., Humberto Reynales, M.D., Ph.D., Xavier Saez-Llorens, M.D., Pio Lopez, M.D., Charissa Borja-Tabora, M.D., Pope Kosalaraksa, M.D., Chukiat Sirivichayakul, M.D., Veerachai Watanaveeradej, M.D., Luis Rivera, M.D., Felix Espinoza, M.D., LakKumar Fernando, M.D., Reynaldo Dietze, M.D., et al., for the TIDES Study Group*

BACKGROUND

Dengue, a mosquito-borne viral disease, was designated a World Health Organization top 10 threat to global health in 2019.

METHODS

We present primary efficacy data from part 1 of an ongoing phase 3 randomized trial of a tetravalent dengue vaccine candidate (TAK-003) in regions of Asia and Latin America in which the disease is endemic. Healthy children and adolescents 4 to 16 years of age were randomly assigned in a 2:1 ratio (stratified according to age category and region) to receive two doses of vaccine or placebo 3 months apart. Participants presenting with febrile illness were tested for virologically confirmed dengue by serotype-specific reverse-transcriptase polymerase chain reaction. The primary end point was overall vaccine efficacy in preventing virologically confirmed dengue caused by any dengue virus serotype.

RESULTS

Of the 20,071 participants who were given at least one dose of vaccine or placebo (safety population), 19,021 (94.8%) received both injections and were included in the per-protocol analysis. The overall vaccine efficacy in the safety population was 80.9% (95% confidence interval [CI], 75.2 to 85.3; 78 cases per 13,380 [0.5 per 100 person-years] in the vaccine group vs. 199 cases per 6687 [2.5 per 100 person-years] in the placebo group). In the per-protocol analyses, vaccine efficacy was 80.2% (95% CI, 73.3 to 85.3; 61 cases of virologically confirmed dengue in the vaccine group vs. 149 cases in the placebo group), with 95.4% efficacy against dengue leading to hospitalization (95% CI, 88.4 to 98.2; 5 hospitalizations in the vaccine group vs. 53 hospitalizations in the placebo group). Planned exploratory analyses involving the 27.7% of the per-protocol population that was seronegative at baseline showed vaccine efficacy of 74.9% (95% CI, 57.0 to 85.4; 20 cases of virologically confirmed dengue in the vaccine group vs. 39 cases in the placebo group). Efficacy trends varied according to serotype. The incidence of serious adverse events was similar in the vaccine group and placebo group (3.1% and 3.8%, respectively).

CONCLUSIONS

TAK-003 was efficacious against symptomatic dengue in countries in which the disease is endemic. (Funded by Takeda Vaccines; TIDES ClinicalTrials.gov number, NCT02747927. opens in new tab.)

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMoa1903869?query=TOC

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMoa1903869?articleTools=true

November 21, 2019 at 8:05 am

Measles virus infection diminishes preexisting antibodies that offer protection from other pathogens.

Measles Virus Infection Negatively Affects Host Immune Status

New evidence shows that measles infection decreases the breadth and titers of preexisting antibodies to a wide variety of pathogens

SOURCE

Science. November 1, 2019 V.366 N.6465 P.599-606.

Mina MJ1,2,3, Kula T4,2, Leng Y4, Li M2, de Vries RD5, Knip M6,7, Siljander H6,7, Rewers M8, Choy DF9, Wilson MS9, Larman HB10, Nelson AN11, Griffin DE11, de Swart RL5, Elledge SJ1,2,12.

Author information

1 Division of Genetics, Brigham and Women’s Hospital, Howard Hughes Medical Institute, Boston, MA 02115, USA. selledge@genetics.med.harvard.edu  mmina@hsph.harvard.edu

2 Department of Genetics, Harvard Medical School, Boston, MA 02115, USA.

3 Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA.

4 Division of Genetics, Brigham and Women’s Hospital, Howard Hughes Medical Institute, Boston, MA 02115, USA.

5 Department of Viroscience, Postgraduate School of Molecular Medicine, Erasmus MC, University Medical Centre Rotterdam, 3015 CN, Rotterdam, Netherlands.

6 Children’s Hospital, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland.

7 Research Program for Clinical and Molecular Metabolism, University of Helsinki, 00014 Helsinki, Finland.

8 Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Denver, CO 80045, USA.

9 Genentech Inc., South San Francisco, CA 94080, USA.

10 Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.

11 W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.

12Program in Virology, Harvard Medical School, Boston, MA 02115, USA.

Abstract

Measles virus is directly responsible for more than 100,000 deaths yearly. Epidemiological studies have associated measles with increased morbidity and mortality for years after infection, but the reasons why are poorly understood. Measles virus infects immune cells, causing acute immune suppression. To identify and quantify long-term effects of measles on the immune system, we used VirScan, an assay that tracks antibodies to thousands of pathogen epitopes in blood. We studied 77 unvaccinated children before and 2 months after natural measles virus infection. Measles caused elimination of 11 to 73% of the antibody repertoire across individuals. Recovery of antibodies was detected after natural reexposure to pathogens. Notably, these immune system effects were not observed in infants vaccinated against MMR (measles, mumps, and rubella), but were confirmed in measles-infected macaques. The reduction in humoral immune memory after measles infection generates potential vulnerability to future infections, underscoring the need for widespread vaccination.

FULL TEXT

https://science.sciencemag.org/content/366/6465/599.long

PDF

https://science.sciencemag.org/content/sci/366/6465/599.full.pdf

November 18, 2019 at 7:04 pm

Colonization of β-hemolytic streptococci in patients with erysipelas—a prospective study

European Journal of Clinical Microbiology & Infectious Diseases October 2019 V.38 N.10 P.1901–1906

Erysipelas is a common skin infection causing significant morbidity. At present there are no established procedures for bacteriological sampling.

Here we investigate the possibility of using cultures for diagnostic purposes by determining the perianal colonization with beta-hemolytic streptococci (BHS) in patients with erysipelas.

Patients with erysipelas and a control group of patients with fever without signs of skin infection were prospectively included and cultures for BHS were taken from the tonsils, the perianal area, and wounds.

BHS were grouped according to Lancefield antigen, species-determined, and emm-typed. Renewed cultures were taken after four weeks from patients with erysipelas and a positive culture for BHS. 25 patients with erysipelas and 25 with fever were included.

In the group with erysipelas, 11 patients (44%) were colonized with BHS, ten patients were colonized in the perianal area, and one patient in the throat.

In contrast, only one patient in the control group was colonized (p = 0.005 for difference). All of the patients with erysipelas colonized with BHS had an erythema located to the lower limb.

The BHS were then subjected to MALDI-TOF MS and most commonly found to be Streptococcus dysgalactiae. Renewed cultures were taken from nine of the 11 patients with BHS and three of these were still colonized.

Streptococcus dysgalactiae colonizes the perianal area in a substantial proportion of patients with erysipelas.

The possibility of using cultures from this area as a diagnostic method in patients with erysipelas seems promising.

FULL TEXT

https://link.springer.com/article/10.1007/s10096-019-03625-9?wt_mc=alerts.TOCjournals&utm_source=toc&utm_medium=email&utm_campaign=toc_10096_38_10

PDF

https://link.springer.com/content/pdf/10.1007%2Fs10096-019-03625-9.pdf

November 12, 2019 at 3:50 pm

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