DIAGNOSTICO DE DENGUE

DIAGNOSIS OF DENGUE INFECTION USING VARIOUS DIAGNOSTIC TESTS IN THE EARLY STAGE OF ILLNESS
Rangsima Lolekha
Abstract. In order to elucidate the usefulness of various tests in the early course of dengue infection, in terms of diagnosis and correlation with clinical severity, blood specimens were collected every 48 hours on 3 occasions from patients with clinical suspicion of dengue infection with fever for less than 4 days. Viral isolation was attempted by mosquito inoculation (MI), tissue culture inoculation (TC), and reverse transcriptase polymerase chain reaction (RT-PCR). Antibodies were detected by hemagglutination inhibition test (HI), an in-house-ELISA (IH-ELISA), and an ELISA by MRL diagnostics Clinical data were collected from the time of enrollment to complete recovery. Of the 40 patients enrolled, 31 were diagnosed as dengue infection and confirmed by either serology or viral isolation. Of these, 12 had primary infection and 19 had secondary infection. Dengue fever occurred in 9 cases. Dengue viruses were isolated from 28 out of 31 patients, and dengue hemorrhagic fever was diagnosed in 22 patients. Viral serotypes identified by viral isolation, and RT-PCR were concordant: DEN1 was isolated in 8, DEN2 in 13, DEN3 in 5, and DEN4 in 2 patients. Viral isolation yielded positive results on blood collected before the 5th day of fever. MI was more sensitive than TC. RT-PCR was less sensitive than viral isolation during the early days of fever, but became more sensitive after the 5th day of fever. RT-PCR was able to detect virus up to day 7-8 of fever, even after defervescence, and in the presence of antibody. During the febrile stage, serological diagnosis on blood samples taken 48 hours apart was carried out by HI, IH-ELISA, and MRL-ELISA, facilitating diagnosis in 3 (10%), 21 (67%), and 27 (87%) of patients, respectively. All of the patients with secondary infection were diagnosed by MRL-ELISA before defervescence. By the 8th day of fever, a serological diagnosis aided to diagnose in 9 (29%), 29 (93%), and 31 (100%) of patients by HI, IH-ELISA, and MRL-ELISA, respectively.

LINK
http://www.tm.mahidol.ac.th/seameo/2004/35_2/27-3214.pdf

FAVOR DE COMENTAR EL ARTICULO EN MINIMO UNA CUARTILLA (USAR CITAS BIBLIOGRAFICAS REV. MED)

EVALUACION PRUEBAS RAPIDAS PARA INFLUENZA H1N1

Evaluation of Rapid Influenza Diagnostic Tests for Detection of Novel Influenza A (H1N1) Virus --- United States, 2009

Preliminary data from the CDC suggest that rapid influenza diagnostic tests have a low overall sensitivity for novel influenza A (H1N1), MMWR reports.
Sixty-five respiratory specimens that tested positive for novel influenza A (H1N1) or seasonal influenza A (H1N1 or H3N2) by reverse-transcription polymerase chain reaction were tested again using three rapid tests.

Among the findings:
Overall sensitivity for novel influenza A ranged from 40% to 69%.
For nine specimens with high viral titers of novel influenza A, sensitivity ranged from 89% to 100%.
The tests were generally more sensitive for seasonal flu (range, 60% to 83%) than for novel influenza A.
An editorial note concludes that, for now, all results from rapid tests in suspected H1N1 cases "should be interpreted in the context of circulating influenza virus strains in the patient's community, level of clinical suspicion, severity of illness, and risk for complications."

LINK(S):
MMWR reports.

FAVOR DE COMENTAR EL ARTICULO EN MINIMO UNA CUARTILLA (USAR CITAS BIBLIOGRAFICAS REV. MED)

VIDEO RESPUESTA INMUNE

APRENDIZAJE BASADO EN UN CASO

Mujer de 71 años de edad que se presenta en el servicio de urgencias a causa de hematuria iniciada recientemente. La paciente aparece apática e indiferente. Es transportada en silla de ruedas a causa de una debilidad progresiva que comenzó seis meses atrás, y hace tres que es incapaz de caminar.
En el examen físico se aprecia: Presión arterial 100/70 mm Hg, pulso 86 ppm. Lengua carnosa y no se aprecian papilas. El examen neurológico reveló paraplejia en miembros inferiores y abolición de los reflejos rotuliano y aquíleo, estando conservada la sensibilidad. Analítica (entre paréntesis los valores normales para mujeres):


Hb:10.9 g/dL (12-16)
Hematocrito: 32% (37-48)
VCM: 86.5 (80-100)
HCM: 31.6 pg (27-32)
CHCM: 36.6g/dl (32-37)
Plaquetas: 50.000/mm3 (130.000-400.000)
Leucocitos: 11600/mm3 (4300-10.800)
Neutrófilos segmentados 90%
Neutrófilos banda 2%
En el frotis de sangre periférica no se aprecian esquistocitos.
Tiempo de protrombina y tiempo parcial de tromboplastina normales.
LDH: 246 U/mL
Bilirrubina total: 0.7 mg/dl (0.3-1.0)
Creatinina: 0.4 mg/dL (inferior a 1.5)

Se realizó punción medular, revelando marcados cambios megaloblásticos. Los niveles de vitamina B12 fueron 92 pg/mL (200-950) y ácido fólico 6.2 ng/mL (3-17). Se realizó gastroscopia, observándose signos de gastritis atrófica, confirmada mediante biopsia

Señale el diagnostico probable, pruebas de laboratorio necesarias para corroborarlo y tratamiento probable.

VIDEO SOBRE MODELO DE COAGULACION

CASO CLINICO

Paciente femenina de 69 años con antecedentes de falla renal crónica, gota y anemia pluricarencial que consultó por presentar un cuadro de debilidad generalizada, fiebre no cuantificada sin predominio horario asociada a cefalea generalizada de tipo pulsátil. Además tres días antes de ser ingresada presentó disartria y desviación de la comisura labial hacia la izquierda con recuperación total y espontánea. Refiere que hace un mes desarrolló un hematoma cuando se le administró una inyección i.m. de hierro, posterior a la cual ha venido desarrollando equimosis en miembros superiores, petequias y púrpuras en miembros inferiores y en la cara, lo que ha aparecido espontáneamente sin causa aparente. Niega cualquier trauma o lesión. Al examen físico presenta equimosis en miembro superior izquierdo de 5cm de diámetro, petequias y púrpuras en miembros superiores e inferiores y en la mejilla izquierda.

El hemograma
Hb: 7.1, Hto:19.6, VCM: 88.1, HCM: 31.7, CMHC: 35.9, ADE: 13.9
PQ: 30,000
TP: 12,2
TPT: 31,0
la biopsia de médula ósea demostró presencia de megacariocitos,
La tomografía computada reveló lesiones hipoxico-isquémicas en ambos lóbulos frontales y parietal derecho; hematoma subdural laminar frontal derecho y pequeño higroma subdural frontal izquierdo
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