RESUMO
Erythrostemon yucatanensis (Greenm.) Gagnon & GP Lewis is a legume tree native to and widely distributed in southeast Mexico, where its branches are used in traditional medicine. An in vitro evaluation of the antiviral activity of extracts and fractions from the leaves, stem bark and roots against two strains of the AH1N1 influenza virus was performed, leading to the identification of bioactive compounds in this medicinal plant. In a cytopathic effect reduction assay, the fractions from the leaves and stem bark were the active elements at the co-treatment level. These were further fractionated based on their hemagglutination inhibition activity. The analysis of spectroscopy data identified a combination of phytosterols (ß-sitosterol, stigmasterol and campesterol) in the stem bark active fraction as the main anti-hemagglutinin binding components, while 5-hydroxy-2(2-hydroxy-3,4,5-trimethoxyphenyl)-7-metoxi-4H(chromen-4-ona), which was isolated from the leaf extracts, showed a weak inhibition of viral hemagglutinin. Time of addition experiments demonstrated that the mixture of sterols had a direct effect on viral particle infectivity at the co-treatment level (IC50 = 3.125 µg/mL). This effect was also observed in the virus plaque formation inhibition assay, where the mixture showed 90% inhibition in the first 20 min of co-treatment at the same concentration. Additionally, it was found using qRT-PCR that the NP copy number was reduced by 92.85% after 60 min of co-treatment. These results are the first report of components with anti-hemagglutinin binding activity in the genus Erythrostemon sp.
Assuntos
Fabaceae , Vírus da Influenza A Subtipo H1N1 , Vírus da Influenza A , Influenza Humana , Antivirais/química , Bioensaio , Hemaglutininas , Humanos , Extratos Vegetais/químicaRESUMO
We describe three clinical cases of Surinamese children with rhabdomyolysis with diverse clinical presentation and course. The first patient had rhabdomyolysis because of toxins caused by multiple beestings and developed acute kidney injury. The other two patients had rhabdomyolysis following acute infection with chikungunya and influenza A/H1N1 virus. These cases emphasize that the diverse etiology of rhabdomyolysis should be considered in children in tropical settings.
Assuntos
Venenos de Abelha/intoxicação , Abelhas , Febre de Chikungunya/complicações , Influenza Humana/complicações , Mordeduras e Picadas de Insetos/complicações , Rabdomiólise/etiologia , Injúria Renal Aguda/etiologia , Adolescente , Animais , Febre de Chikungunya/diagnóstico , Vírus Chikungunya/isolamento & purificação , Criança , Pré-Escolar , Humanos , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/diagnóstico , Masculino , Rabdomiólise/fisiopatologia , SurinameRESUMO
We present the case of a 12-year-old boy with acute lymphocytic leukemia who developed pneumonia and multiple brain infarcts compatible with acute necrotic encephalitis. The infectious disease screening tests revealed influenza A H1N1 virus, Staphylococcus aureus in broncho alveolar lavage, E. coli and galactomannan antigen in blood. CNS influenza associated complications are reviewed. This case highlights the importance of magnetic resonance imaging as a diagnostic tool in the assessment of immunocompromised patients with CNS compromise and the value of brain biopsy in the final identification of an infectious disease etiology.
Escolar de 12 años de edad, con Leucemia Linfocítica Aguda en tratamiento que desarrolla una bronconeumonía bilateral, infartos cerebrales compatibles con encefalitis necrosante aguda. El estudio infectológico demostró más de una causas infecciosa que pudiera explicar su evolución destacando influenza A H1N1, Staphylococcus aureus meticilina sensible en lavado bronco alveolar, E. coli y galactomanano en sangre. Se revisa el compromiso del SNC por influenza A H1N1. Se destaca la importancia del uso de resonancia magnética nuclear al evaluar pacientes inmunocomprometidos con complicaciones neurológicas y el aporte de una biopsia cerebral en aclarar la etiología de este compromiso.
Assuntos
Criança , Humanos , Masculino , Encefalite Viral/virologia , Hospedeiro Imunocomprometido/imunologia , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/virologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/imunologia , Líquido da Lavagem Broncoalveolar/microbiologia , Encefalite Viral/imunologia , Infecções por Escherichia coli/diagnóstico , Evolução Fatal , Influenza Humana/imunologia , Imageamento por Ressonância Magnética , Infecções Estafilocócicas/diagnósticoRESUMO
En la primera pandemia del siglo XXI por virus influenza A/H1N1, una importante proporción de paciente que desarrollaron neumonía y Falla Respiratoria Aguda (FRA) eran obesos. La obesidad ha sido propuesta como un factor de riesgo que aumenta la morbimortalidad; sin embargo, hay controversia al respecto. Objetivo: evaluar el impacto de la obesidad en complicaciones, estadía y/o mortalidad en pacientes adultos graves por virus influenza A/H1N1. Estudio observacional y multicéntrico realizado en 17 UCIs de Chile durante el periodo mayo-agosto 2009. Fueron incluidos en el estudio solo paciente con infección por virus Influenza A/H1N1 confirmada o probable. Los paciente obesos (IMC>30) fueron comparados con pacientes no obesos. Resultados: De un total de 136 pacientes incluidos en el estudio, 64 (47 por ciento) fueron obesos y de estos 13 obesos mórbidos (BMI >40). Los pacientes obesos tienen mayor frecuencia de: comorbilidades, ventilación mecánica y complicaciones. La estadía en UCI y en el hospital fue más prolongada en pacientes obesos (18,1+/-15 vs. 10,9+/-10,2, p=0,002 y 27,2+/-24,7 vs17,7 +/- 14,6, p=0,01 respectivamente). La mortalidad fue mayor en pacientes obesos (36 por ciento vs. 19,4 por ciento; OR 2,32; IC95 por ciento 1,07-5,05, p=0.035). El estudio de regresión logística encuentra que la FOM es un factor pronóstico independiente de mortalidad en pacientes obesos. Conclusiones: Los pacientes obesos con neumonía grave por virus influenza A/H1N1 tienen una mayor morbi-mortalidad y prolongación de su estadía en UCI y en el hospital. El desarrollo de FOM en pacientes obesos es un factor de mal pronóstico.
In the first pandemic of the 21st century due to influenza A/H1N1 virus, a significant proportion of patients who developed pneumonia and acute respiratory failure (ARF) were obese. Obesity has been proposed as a risk factor that increases morbidity and mortality, however, there is controversy about it. Objective: To determine the impact of obesity on complications, stay and / or mortality in adult patients with severe influenza A/H1N1 virus. Multicenter observational study conducted in 17 ICUs of Chile during the period May to August 2009. Were included only patients with influenza A/H1N1 virus infection confirmed or probable. Obese patients (BMI> 30) were compared with non obese patients. The results: Of a total of 136 patients included in the study, 64 (47 percent) were obese and of these 13 morbidly obese (BMI> 40). Obese patients have a higher frequency of: comorbidities, mechanical ventilation and complications. The stay in ICU and hospital was longer in obese patients (18.1 +/- 15 vs. 10.9 +/- 10.2, p = 0.002 and 27.2 +/- 24.7 vs17, 7 +/- 14.6, p = 0.01 respectively). Mortality was higher in obese patients (36 percent vs. 19.4 percent, OR 2.32, 95 percent CI 1.07 to 5.05, p = 0,035). The logistic regression analysis found that the MOF is an independent predictor of mortality in obese patients. Conclusions: Obese patients with severe pneumonia due to the influenza A/H1N1 virus have a high morbidity and mortality and prolonged stay in ICU and hospital. MOF development in obese patients is a poor prognostic factor.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Pessoa de Meia-Idade , Influenza Humana/epidemiologia , Pneumonia Viral/epidemiologia , Obesidade/epidemiologia , Índice de Massa Corporal , Comorbidade , Chile/epidemiologia , Influenza Humana/mortalidade , Influenza Humana/virologia , Unidades de Terapia Intensiva , Tempo de Internação , Modelos Logísticos , Estudos Multicêntricos como Assunto , Pneumonia Viral/mortalidade , Obesidade/complicações , Obesidade/mortalidade , Análise de Sobrevida , Vírus da Influenza A Subtipo H1N1/isolamento & purificaçãoRESUMO
INTRODUCCIÓN: Oseltamivir es un medicamento antiviral usado para profilaxis y tratamiento de la gripe. Sus efectos adversos son conocidos a través de los ensayos clínicos y por la experiencia adquirida en la última epidemia de gripe aviar. Dentro de las reacciones más graves se han reportado casos de anafilaxia, eventos cutáneos y manifestaciones psiquiátricas como alucinaciones, delirium e ideación suicida. OBJETIVO: en julio de 2009, el departamento de Farmacovigilancia de ANMAT lanzó el Plan Nacional de Farmacovigilancia para Drogas Antivirales con el objetivo de recolectar mayor información de seguridad de estos medicamentos durante su uso masivo, con especial atención a las manifestaciones cutáneas, hepáticas y neuropsiquiátricas. MÉTODOS: se analizaron todas las notificaciones recibidas durante junio - noviembre de 2009. Los datos considerados fueron: sexo, edad, notificador, modalidad terapéutica, severidad, clasificación delefecto adverso principal e imputabilidad asignada. RESULTADOS: serecibieron 179 notificaciones, la mayoría asociadas a la modalidad tratamiento. Las reacciones adversas más reportadas involucraron al sistema gastrointestinal, siendo en su mayoría leves y autolimitadas. Con respecto a los casos psiquiátricos reportados, su severidad y variabilidad obliga a prestar especial atención a estas notificaciones. Se reportaron además casos de prolongación del Intervalo QTc, evento no descripto previamente en la literatura. CONCLUSIÓN: Dada la escasa experiencia en la Argentina y el estrecho perfil de seguridad de este fármaco, es indispensable continuar con una vigilancia activa del mismo.
INTRODUCTION: Oseltamivir is an antiviral drug used for profhylaxis and treatment of influenza. Adverse effects are known through clinical trials and in large part by the experience gained after its use in the last outbreak of avian influenza in Asia. Among the most serious reactions are reported cases of anaphylaxis, cutaneous events and psychiatric symptoms such as hallucinations, delirium and suicidal behaviour. OB JECTIVE: in line with various international regulatory authori ties, during July 2009, the ANMAT through Pharmacovigilance Department launched the National Pharmacovigilance Plan for antiviral drugs used for prophylaxis and treatment of the pandemic H1N1 influenza virus. The plan called for reporting any signs or symptoms, paying particular attention to the cutaneous, hepatic and neuropsychiatric symptoms. METHOD:we analyzed all reports received during June to November 2009. The data considered were: sex, age, notifier, therapeutic modality, severity, classification of main side effect and imputation assigned. RESULTS: 179 notifications were received, most associated with treatment modality. As can be seen world wide, in Argentina, the great majority of reported adverse reactions involve the gastrointestinal system, being mostly mild and self-limiting. Given the variability and severity of psychiatric cases reported it is very important to pay close attention to these reports. Reported cases include the QTc interval prolongation, an event not previously described in the literature. CONCLUSIONS: it is essential to continu e with proactive monitoring of this drug because of the limited current experience and the benefits/ risks ratio of the safety profile of this drug.
Assuntos
Humanos , Oseltamivir/efeitos adversos , Oseltamivir/uso terapêutico , Sistemas de Notificação de Reações Adversas a Medicamentos , Vírus da Influenza A Subtipo H1N1 , Vírus da Influenza A Subtipo H1N1/imunologia , Vigilância Sanitária , Zanamivir/uso terapêuticoRESUMO
A partir de la transmisión sostenida del virus de Gripe A(H1N1) en distintos países, la Organización Mundial de la Salud declaró el comienzo de la primera pandemia de influenza del siglo XXI el 11de junio de 2009. En Argentina, la región sanitaria V de la provincia de Buenos Aires fue una de las primeras afectadas en todo el país. OBJETIVO:realizar un análisis descriptivo de las notificaciones registradas de los casos de Gripe A (H1N1) en dicha región hasta el 20 de septiembre de 2009. MÉTODO: se trabajó con fuentes secundarias. La confirmación de casos (PCR en tiempo real) fue realizada en instituciones autorizadas. Variables consideradas: casos sospechosos, confirmados y fallecidos, sexo, edad, municipios, antecedentes epidemiológicos, embarazadas, fecha de inicio de síntomas y circulación viral por semana epidemiológica. RESULTADOS: se registraron 1.332 notificaciones de casos sospechosos y 949 confirmados. El mayor número de confirmados se registró en los municipios de Gral. San Martín (94), San Isidro (90), Pilar (85) y Vicente López (80). Las semanas epidemiológicas 23, 24 y 25 registraron la mayor cantidad de casos confirmados. Los grupos de edad que más confirmados aportaron fueron: de 5 a 9 años (121), 1 a 4 (89) y 10 a 14 (75) (cuya mediana de edad fue de 30 años). Se registraron 64 casos confirmados fallecidos. La tasa más alta de mortalidad específica por grupo de edad correspondió a menores de un año. Se registraron 9 casos confirmados en embarazadas y una puérpera, 5 de ellas fallecieron. CONCLUSIÓN: todos los municipios presentaron casos confirmados y 11 reportaron fallecidos. El pico de la epidemia se adelantó en una semana al registrado a nivel nacional y la mediana de edad en fallecidos fue más baja que la de todo el país. El análisis de mortalidad mostró un mayor riesgo para varones, embarazadas y menores de un año.
From the sustained transmission of influenza virus A (H1N1) in different countries, the World Health Organization declared the beginning of the first influenza pandemic of the twenty first century on June 11, 2009. In Argentina, the Health Region V of the Province of Buenos Aires was one of the first affected across the country. OBJECTIVE: to conduct a descriptive analysis of notifications of cases of Influenza A (H1N1) in that region until September 20, 2009. METHODS: we worked with secondary sources. The confirmation of cases (real-time PCR) was carried out in authorized institutions. Variables considered: suspected cases, confirmed and diseased, sex, age, municipalities, epidemiological history, pregnant, date of on set of symptoms and viral movement by epidemiological week. RESULTS: there were 1.332 notifications of suspected cases and 949 confirmed. The highest number of confirmed cases was in the municipalities of Gral. San Martin (94), San Isidro (90),Pilar (85) and Vicente López (80). The epidemiological weeks 23,24 and 25 showed the highest number of confirmed cases. Giventhe age group, which contributed more confirmed cases was that of 5-9 years (121), followed by 1-4 (89) and 10-14 (75). The median age was 30 years. There were 64 confirmed cases dead. The high estrate of cause-specific mortality by age group accounted for less than one year. There were nine conf irmed cases in pregnant and puerperal women, five of them died. CONCLUSION: all municipalities had confirmed cases and 11 confirmed deaths reported. The peak of the epidemic one week a head of the national and the medianage was lower than the registered for the rest of the country. The analysis of mortality showed a higher risk for men, pregnant women and children under one year.
Assuntos
Humanos , Ocupações em Saúde/educação , Doenças Respiratórias/complicações , Doenças Respiratórias/mortalidade , Doenças Respiratórias/patologia , Vírus da Influenza A Subtipo H1N1/imunologia , Mortalidade/estatística & dados numéricos , Vacinação em Massa/organização & administração , Monitoramento Epidemiológico/estatística & dados numéricos , Epidemiologia DescritivaRESUMO
OBJETIVO: Descrever as alterações na tomografia computadorizada de tórax de casos comprovados de infecção pelo novo vírus influenza A (H1N1). MATERIAIS E MÉTODOS: Três observadores avaliaram, em consenso, nove tomografias computadorizadas de pacientes com infecção pelo vírus influenza A (H1N1) comprovada laboratorialmente. A idade dos pacientes variou de 14 a 64 anos (média de 40 anos), sendo cinco do sexo masculino e quatro do sexo feminino. Quatro pacientes eram previamente hígidos, quatro eram transplantados renais e uma era gestante à época do diagnóstico. Foram avaliadas a presença, a extensão e a distribuição de: a) opacidades em vidro fosco; b) nódulos centrolobulares; c) consolidações; d) espessamento de septos interlobulares; e) derrame pleural; f) linfonodomegalias. RESULTADOS: As alterações mais frequentemente encontradas foram opacidades em vidro fosco, nódulos centrolobulares e consolidações, presentes em nove (100 por cento), cinco (55 por cento) e quatro (44 por cento) dos casos, respectivamente. Derrames pleurais e linfonodomegalias foram menos comuns, ocorrendo em apenas dois (22 por cento) dos casos estudados. CONCLUSÃO: Os achados mais comuns nos casos de infecção pelo novo vírus influenza A (H1N1) foram opacidades em vidro fosco, nódulos centrolobulares e consolidações. Estas alterações não são típicas ou únicas a este agente, podendo ocorrer também em outras infecções virais ou bacterianas.
OBJECTIVE: The objective of this study was to describe chest computed tomography findings in confirmed cases of infection by the novel influenza A (H1N1) virus. MATERIALS AND METHODS: Computed tomography studies of nine patients with laboratory-confirmed infection by the novel influenza A (H1N1) virus were consensually evaluated by three observers. The sample of the present study included five male and four female patients with ages ranging from 14 to 64 years (mean, 40 years). Four of the patients were previously healthy, four were kidney transplant recipients and one was pregnant at the time of diagnosis. Presence, extent and distribution of the following findings were evaluated: a) ground-glass opacities; b) centrilobular nodules; c) consolidation; d) interlobular septa thickening; e) pleural effusion; f) lymphadenopathy. RESULTS: The most frequent findings were ground-glass opacities, centrilobular nodules and consolidations, present in nine (100 percent), five (55 percent) and four (44 percent) of cases, respectively. Pleural effusions and lymphadenopathy were less common findings, occurring in only two (22 percent) of the cases. CONCLUSION: Ground-glass opacities, centrilobular nodules and consolidation were the most frequent findings in cases of infection by the novel influenza A (H1N1) virus. These changes are not typical or unique to this agent and may also occur in other viral or bacterial infections.