Browsing by Author "Brito, M.J."
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- Borrelia lusitaniae infection mimicking headache, neurologic deficits, and cerebrospinal fluid lymphocytosisPublication . Vieira, J.P.; Brito, M.J.; Lopes de Carvalho, I.Headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HaNDL) is a rare headache syndrome included in the Classification of Headache of the International Headache Society as a “headache attributed to non-infectious inflammatory intracranial disease.” We report one 15-year-old patient with clinical history and cerebrospinal fluid findings compatible with the diagnosis of HaNDL in whom Borrelia lusitaniae was identified in cerebrospinal fluid by polymerase chain reaction.
- Borreliose de Lyme em idade PediátricaPublication . Borges, M.; Gouveia, C.; Vieira, J.P.; Lopes de Carvalho, I.; Brito, M.J.Introdução e objetivos: A doença de Lyme é uma entidade rara na idade pediátrica, causada por espiroquetas do complexo Borrelia burgdorferi sensu lato. Pode afetar vários orgãos como pele,sistema nervoso, articulações e coração. Objetivo: Caracterizar a infeção por Borrelia num hospital pediátrico terciário.
- Borreliosis as a cause of myocarditis in pediatric agePublication . Constante, A.D.; Lemos, A.; Trigo, C.; Lopes de Carvalho, I.; Brito, M.J.Introduction: Lyme borreliosis (LB) is a zoonosis with worldwide distribution, mainly in the northern hemisphere countries with predominantly cutaneous, articular, cardiac and neuro-psychiatric manifestations. The greater variety of genospecies that cause disease in Europe and the complex laboratory confirmation contribute to the disease underdiagnose in Portugal. Case description: A 17-year-old boy resident in a rural area, with a history of recurrent tonsillitis, initiates cervical pain, odynophagia and fever (39ºC). Blood work showed leukocytosis (11280/uL) and neutrophilia (8569/uL) and CRP 23.6mg/L. Oropharynx antigen screening for SGA and EBV antibodies were negatives but he was discharged with amoxicillin and clavulanic acid. The next day (7th day of disease) he kept fever (38.3°C), initiated a pruritic maculopapular rash on the face, trunk and limbs with palmoplantar involvement and started complaining of thoracic pain that worsened with decubitus. Blood work revaluation indicated increased leukocytosis (14640/uL) and neutrophilia (11040/uL), CRP 142mg/L, VHS 22mm/h. Chest x-ray had a discreet broncho-hilar reinforcement without pleural effusion or cardiomegaly. Electrocardiogram (EKG) in sinus rhythm, with mild infra ST in DIII and aVF, inverted T wave in V1 and V4 and early repolarization pattern in V2-V3. Due to an episode of tachycardia (270 bpm), cardiac markers were accessed and showed troponin 13932pg/mL, CK 436U/L and BNP 373pg/mL, echocardiography showed slight global left ventricular dysfunction and hyperechogenic pericardium without effusion. He was admitted with clindamycin and penicillin and started anti-congestive therapy with carvedilol and enalapril. On the 10th day of disease, of the etiology investigation it was identified by enzyme-linked immunosorbent assay (ELISA) for Borrelia burgdorferi s.l. IgM antibodies positive (53 UA/mL), IgG antibodies negative with confirmatory test-immunoblot IgM positive with bands OspC Bg, p39, p41. Antibiotic therapy was changed to ceftriaxone and doxycycline which he complied with for 8 and 7 days, respectively. On the 20th day of disease cardiac magnetic resonance showed active inflammatory process in the myocardium, but undilated ventricles with preserved global systolic function. Progressive improvement of cardiac markers was noticed, currently with good ventricular function and at the last observation he was asymptomatic from the cardiovascular point of view. Conclusions: LB with myocarditis is a rarity in pediatrics and diagnosis requires a high index of suspicion. When LB cardiac involvement is readily recognized and treated serious complications can be avoided
- Detection of Dientamoeba fragilis in Portuguese children with acute gastroenteritis between 2011 and 2013Publication . Júlio, C.; Furtado, Cristina; Rocha, R.; Escobar, C.; Brito, M.J.; Oleastro, MónicaDientamoeba fragilis is an inhabitant of human gastrointestinal tract with a worldwide distribution. The first description considered this protozoan a rare and harmless commensal, since then it has struggled to gain recognition as a pathogen. Commercial multiplex real-time PCR was used to detect D. fragilis in fecal samples from hospitalized children (⩽18 years) with acute gastrointestinal disease, admitted to two hospitals of Lisbon area, with different demographic characteristics. A total of 176 children were studied, 103 (58·5%) male, 144 (81·8%) children between 0 and 5 years and 32 (18·2%) above 6 years old. The overall protozoa frequency considering the four tested microorganisms were 8·5% (15/176), and the most frequently found protozoan was D. fragilis, 6·3% (11/176). Dientamoeba fragilis frequency was higher among older children (21·9%), than younger children (2·8%), and greater in boys (6·8%) than in girls (5·5%). All positive children presented with diarrhoea associated with vomiting, fever and abdominal pain. Infection was associated with the age of children (P < 0·001), school attendance (P = 0·002) and consumption of certain foods (P = 0·014), e.g. cakes with crème and ham. The frequency of diantamoebiasis found in a cohort of hospitalized Portuguese children, with acute gastrointestinal disease, could be considered a very high value when compared with the protozoan frequency normally associated with this pathology.
- Kikuchi Fujimoto’s disease: fever of unknown origin and lymphadenitisPublication . Soares, T.S.; Mafra, M.; Lopes de Carvalho, I.; Gouveia, C.; Brito, M.J.Kikuchi Fujimoto’s disease (KFD) or histiocytic lymphadenitis is especially rare in paediatrics. Although it is a self-limited and benign disease, its differential diagnose is vast including lymphoma, various infections and autoimmune diseases.
- Outbreak of acute respiratory infection among infants in Lisbon, Portugal, caused by human adenovirus serotype 3 and a new 7/3 recombinant strainPublication . Rebelo-de-Andrade, Helena; Pereia, C.; Giria, M.; Prudêncio, E.; Brito, M.J.; Calé, E.; Taveira, N.Human adenoviruses (AdVs) typically cause mild illnesses in otherwise healthy hosts. We investigated a pediatric outbreak of acute respiratory infection with fatal outcomes that occurred in Lisbon, Portugal, in 2004.Biological specimens were collected from 83 children attending two nurseries, a kinesiotherapy clinic, and the household of a nanny. Adenovirus infection was confirmed in 48 children by PCR and virus isolation. Most(96%) isolates were classified as being of subspecies B1. Phylogenetic analysis of fiber and hexon gene sequences revealed that most infants were infected with AdV serotype 3 (AdV3) strains. Infants attending one nursery harbored a new recombinant strain containing an AdV serotype 7 hexon and serotype 3 fiber (AdV7/3). Both the AdV3 and the AdV7/3 strains caused fatal infections. Two different serotype 3 strains were circulating in Lisbon in 2004, and the new AdV7/3 recombinant type originated from only one of those strains. These results demonstrate that recombination leads to the emergence of new adenovirus strains with epidemic and lethal potential