scholarly journals Neurological impairment of the monozygotic twins with congenital infection presumed by Zika virus: Case report

2018 ◽  
Vol 18 (1) ◽  
pp. 247-252 ◽  
Author(s):  
Ana Karina Rocha Hora Mendonça ◽  
Sonia Oliveira Lima

Abstract Introduction: the increase in the incidence of congenital microcephaly in Brazil has been associated to the Zika virus outbreak. This case report aimed to describe the neurological impairment of monozygotic twins presumably due to an intrauterine infection by Zika virus during the Brazilian outbreak in 2015. Case description: The monozygotic twins born at term with severe congenital microcephaly were taken to the Outpatient Pediatric Service of a University Hospital. The 17-yearold mother, primigravida, lives in the Northeast region of Brazil, has a normal body mass index, no family history of microcephaly, no clinical history of viral diseases, or exposure to drugs and/or radiation during pregnancy. Serological tests for toxoplasmosis, rubella, syphilis, cytomegalovirus and HIV were negative at the prenatal evaluation and the obstetrical ultrasounds showed a monochorionic, diamniotic twin pregnancy without any evidence of neurological abnormalities. In the post-natal, the imaging of the skull, was evidenced of a great neurological impairment in one of the twins, who, in addition to presenting cerebral calcifications, gliosis and subependymal cysts, also had ventriculomegaly with hydrocephalus of supratentorial predominance and more pronounced cerebral atrophy compared to the other twin. Both presented delayed neuropsychomotor development. Discussion: distinct neurological alterations in the monochorionic twins with an infection presumed by Zika virus may raise the hypothesis of the existence of predisposing factors or protection against this viral agent.

PEDIATRICS ◽  
1964 ◽  
Vol 33 (4) ◽  
pp. 546-553
Author(s):  
Richard L. Naeye

The current study presents prenatal data on body, organ and placental development of monovular and diovulvar twins. Most twin measurements match mean values for single gestations through the 24th gestational week. Subsequently, growth of body and organs is not as rapid in twins as in single-born infants. Most measurements for dizygotic twins are greater than measurements for monozygotic twins at equivalent stages of gestation. Finally, a marked intrapair discordance in many body and organ measurements was found in a group of monochorionic twins with a maternal history of hydramnios. This discordance was related to the cross placental transfusion syndrome. The growth retardation evident in a group of 26 twins at birth largely disappeared by the end of the first postnatal year.


PEDIATRICS ◽  
1973 ◽  
Vol 52 (4) ◽  
pp. 609-612
Author(s):  
Barbara Jones ◽  
Havelock Thompson

Aase and Smith1 reported male siblings with congenital hypoplastic anemia and triphalangeal thumbs, and distinguished their disorder as an entity separate from Fanconi's pancytopenia and radial aplasia-thrombocytopenia. Recently, Murphy and Lubin2 described a third patient, also a male, with a similar thumb anomaly, aregenerative anemia, and several associated anomalies not present in the siblings described in the original report. This report describes a fourth male patient with this syndrome and adds the data of an eight-year follow-up with hematologic response to prednisone therapy. CASE REPORT R.P. was initially evaluated at West Virginia University Hospital in 1964 at 10 years of age; he had a history of chronic anemia.


2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Palak Arora ◽  
Lorraine Croot

Abstract Case report - Introduction Chikungunya is a tropical arbovirus transmitted by female Aedes Aegypti or Aedes Abopitus mosquitos. It is not indigenous to UK but occurs in epidemics in Africa and Asia. It often presents with pyrexia, arthralgia or arthritis, myalgia and a maculopapular rash and can mimic both peripheral and axial inflammatory arthritis as well as more common forms of viral arthritis. It can also become chronic leading to disabling symptoms. The diagnosis should be considered in all patients presenting with early inflammatory arthritis who have travelled to affected areas. Case report - Case description A 57-year-old female developed sudden onset fever along with a macular rash whilst visiting South East Asia. She then developed widespread joint pains and severe inactivity stiffness, particularly affecting her ankles. The rash and fever settled after a few days, but her arthralgia persisted in her cervical spine and both small and large joints. She had a history of recurrent episcleritis and had been investigated for axial spondyloarthropathy two years previously, but MRI imaging of the spine and sacroiliac joints did not show any inflammatory changes. Examination in the rheumatology clinic confirmed right medial epicondylitis, bilateral shoulder tenderness, tenderness over the extensor tendons of the feet and painful cervical spine movement. Investigations revealed high inflammatory markers; CRP 29 (0-10 mg/L) and ESR 48 (0-15 mm/hr), a positive rheumatoid factor but negative anti CCP antibodies and a normal white cell count. Acute seronegative spondyloarthropathy was suspected but Chikungunya serology was requested at the suggestion of the patient, because of the history of a mosquito bite. IgM and IgG antibodies were positive on immunofluorescence, confirming recent infection. She was initially given intramuscular depomedrone and non-steroidal anti-inflammatory drugs (NSAIDs) with a short response but required oral prednisolone 20mg daily to suppress the inflammation in her feet. An MRI confirmed an ankle effusion and peroneal tenosynovitis. After 6 months her symptoms improved, and she was able to stop prednisolone completely and she remains well 9 months after the initial infection. Case report - Discussion Chikungunya infection causes musculoskeletal symptoms in all affected patients, but the clinical presentation can highly variable, from mild joint pain to erosive arthritis. It can be divided into three phases: incubation phase, acute phase, and chronic phase. The incubation phase varies between one to twelve days after the mosquito bite. The acute phase begins with high fever, headache, polyarthralgia/arthritis, lymphadenopathy, and anorexia. Joint involvement is often distal and symmetrical affecting the hands, wrists, shoulders, knees, ankles, and feet. A maculopapular rash is common. Dengue virus and Zika virus infection can present similarly. Treatment for acute Chikungunya fever is supportive. Analgesic, anti-pyretic and NSAIDs are used for symptom relief. During the chronic phase, infected people develop symmetrical, migratory, oligoarticular or polyarticular arthritis with morning stiffness and joint oedema, which can last from months to years. Our patient had a previous history which was consistent with seronegative spondyloarthropathy, an acute presentation of inflammatory arthritis and results and imaging which supported this diagnosis. The correct diagnosis could easily have been missed if a travel history had not been taken and the patient’s suspicions ignored. The best treatment for chronic Chikungunya arthritis is unclear. NSAIDs are often the first treatment but, as in this case systemic steroids are often necessary. Conventional synthetic DMARDs have also been reported efficacious. Biologic DMARDS have been used in resistant cases. Case report - Key learning points Chikungunya has emerged as a global disease affecting millions of people with significant musculoskeletal morbidity. Any patient has travelled to endemic areas including Africa and Asia, with fever and joint pain should be screened for Chikungunya virus as well as Dengue virus, and Zika virus. Diagnosis is either by RT PCR (positive 0-7 days of infection or Immunoglobulin M (detectable after 5 – 10 day of infection and persists for few months). Treatment is supportive in acute phase, may require low doses of steroids to aid resolution of symptoms. Conventional DMARDS have shown benefit in chronic phase with ongoing synovitis/tenosynovitis. Patients may know more about rare, endemic diseases than their European doctors and their suspicions about potential diagnoses should always be considered.


Author(s):  
Jamine Cunha Dos Reis ◽  
Patricia Da Silva Santos ◽  
Mayara Francelle Oliveira Barata ◽  
Ilka Veras Falcão

Introdução: Devido o surto de Zika, em 2015/2016, nasceram no Recife/PE bebês com microcefalia, resultando em desenvolvimento atípico. A gravidade do quadro para a saúde pública exigiu resposta rápida, com pesquisas, treinamento e estruturação da rede de saúde. Assim, o terapeuta ocupacional incorporou-se às equipes de estimulação e reabilitação das crianças e à produção de conhecimentos na área. Objetivo: Apresentar a experiência de atendimento a bebês com Síndrome Congênita do Zika Vírus (SCZV), durante estágio curricular de Terapia Ocupacional. Método: Relato de estágio curricular de Terapia Ocupacional utilizando registros clínicos e de supervisão pela orientadora e docente, durante estágio de cinco meses, em um serviço de Doenças Infectocontagiosas de um hospital-escola, referência para atendimento a recém nascidos com a SCVZ. Resultados: Foram atendidos 24 bebês com microcefalia, com idade entre 3 e 10 meses. Foi detectado comprometimento de funções neurológicas, com atraso do desenvolvimento neuropsicomotor, alterações de tônus e dos sistemas visual, auditivo, proprioceptivo, vestibular e tátil. A estimulação foi dirigida as habilidades para o desenvolvimento infantil e criação de ambiente apropriado e seguro visando às aquisições motoras, sensoriais, de comunicação, cognitivas e sociais das crianças. Orientações as famílias, confecção de adaptações, facilitação do brincar e de atividades de vida diária também foram realizadas. Conclusão: O estágio permitiu experienciar às contribuições da Terapia Ocupacional para a estimulação de crianças com microcefalia, capacitando-nos como futuros profissionais para as demandas da atualidade e para a produção de conhecimentos. Abstract Introduction: Due to the outbreak of  the Zika virus, in 2015/2016, many babies were born with microcephaly in Recife/PE, resulting in atypical development. The severity of this panorama for public health required a rapid response, through research, training and structuring of the health network. Thus, occupational therapists were incorporated into the teams for infant stimulation and rehabilitation, and into the production of knowledge in the area. Objective: To describe the experience of assisting children with microcephaly by the Zika Virus, during a curricular internship of occupational therapy. Method: Reports of the curricular internship of occupational therapy. We used the clinical supervision records from the professional and academic training, during 5 months in the infectious diseases infirmary and outpatient clinic at a referral university hospital for congenital Zika virus syndrome in Recife. Results: Twenty-four infants with microcephaly, aged between 3 and 10 months, were treated. We observed neurological impairment, with delayed neuropsychomotor development, and alterations in the tonus and visual, auditory, proprioceptive, vestibular and tactile systems. Stimulation was directed towards the skills for infant development and for creating an appropriate, safe environment in which children were able to acquire motor, sensory, communication, cognitive and social skills. Guidelines for the families, making adaptations, facilitation of playing skills and activities of daily living were also carried out. Conclusion: The training period allowed us to experience the contributions of occupational therapy for the stimulation of children with microcephaly, preparing us as future professionals for the current demands and for the production of knowledge.Keywords: Microcephaly; Occupational Therapy; Early Intervention; Clinical Clerkship; Zika Virus


2018 ◽  
Vol 18 (2) ◽  
pp. 239 ◽  
Author(s):  
Kowthar S. Hassan ◽  
Ghalib Al-Khadouri

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia. As M. pneumoniae pneumonia is usually a mild and self-limiting disease, complications such as pleural effusion occur only rarely. We report a 22-year-old woman who presented to the Emergency Medicine Department of the Sultan Qaboos University Hospital, Muscat, Oman, in 2017 with an eight-day history of fever associated with coughing, chills and rigors. She was diagnosed with M. pneumoniae pneumonia, but subsequently developed pleural effusion which worsened despite treatment with appropriate antimicrobials. The pleural effusion required drainage, which revealed that it was of the more severe exudative type. Following drainage, the patient improved dramatically. She was discharged and advised to continue taking antibiotics.Keywords: Mycoplasma pneumoniae; Bacterial Pneumonia; Pleural Effusion; Antimicrobial Agents; Drainage; Case Report; Oman.


Neurosurgery ◽  
2002 ◽  
Vol 51 (1) ◽  
pp. 221-226 ◽  
Author(s):  
Michael J. Link ◽  
Colin L.W. Driscoll ◽  
Caterina Giannini

Abstract OBJECTIVE AND IMPORTANCE We report the case of a 29-year-old man with Gardner syndrome and an isolated, giant cerebellopontine angle craniopharyngioma. Our description of this patient is only the second case report of a craniopharyngioma arising primarily in the cerebellopontine angle. CLINICAL PRESENTATION The patient presented with a 1-year history of progressive neurological impairment and headache. On the basis of the patient's history of multiple dermal fibromas, a cranial osteoma, familial adenomatous polyposis (FAP), a total abdominal colectomy, and an adenoma of the ampulla of Vater, we diagnosed the patient's condition as Gardner syndrome. INTERVENTION Magnetic resonance imaging showed a large cerebellopontine angle tumor, which was removed through a suboccipital retromastoid craniotomy. The pathological features were those of an adamantinomatous craniopharyngioma. The patient has done well postoperatively and has no new neurological deficits. A careful retrospective review of the preoperative imaging shows that this tumor was located exclusively in the posterior fossa and was not an extension of a sellar, suprasellar, or clival craniopharyngioma. CONCLUSION We present the second reported case of FAP and craniopharyngioma. There is no known genetic link between FAP and craniopharyngioma. Now that the patient has manifested a primary tumor of the central nervous system with FAP, it is unclear whether he should be classified as having Turcot syndrome. For this patient, we recommended vigilant follow-up imaging and forgoing external beam radiotherapy unless there is a documented recurrence of his craniopharyngioma.


2013 ◽  
Vol 07 (S 01) ◽  
pp. S111-S114 ◽  
Author(s):  
Koray Halicioglu ◽  
Hakan Sahin ◽  
Bayram Corekci ◽  
Celal Irgin ◽  
Orcun Toptas

ABSTRACTThis case report defines a case of isolated oligodontia of 9 and 10 permanent teeth in 9-year-old monozygotic twin sisters and gives information about the possible genetic and environmental etiology, related dental anomalies and treatment options. The twins have a negative family history of hypodontia and oligodontia in their parents, as well as their paternal and maternal grandmothers and first cousins. No other dental anomalies could be detected in either of the twins. With the occurrence of similarly located tooth agenesis, except for one tooth, in monozygotic twins, one may consider the influence of genetic and/or environmental factors in their etiology. Hereditary relationships associated with oligodontia could help the clinicians to predict the possibility of its occurrence in other family members and in the next generations. However, clinicians should consider oligodontia when it is not hereditary.


VASA ◽  
2011 ◽  
Vol 40 (3) ◽  
pp. 251-255 ◽  
Author(s):  
Gruber-Szydlo ◽  
Poreba ◽  
Belowska-Bien ◽  
Derkacz ◽  
Badowski ◽  
...  

Popliteal artery thrombosis may present as a complication of an osteochondroma located in the vicinity of the knee joint. This is a case report of a 26-year-old man with symptoms of the right lower extremity ischaemia without a previous history of vascular disease or trauma. Plain radiography, magnetic resonance angiography and Doppler ultrasonography documented the presence of an osteochondrous structure of the proximal tibial metaphysis, which displaced and compressed the popliteal artery, causing its occlusion due to intraluminal thrombosis..The patient was operated and histopathological examination confirmed the diagnosis of osteochondroma.


2019 ◽  
Vol 98 (8) ◽  
pp. 326-327 ◽  

Introduction: The umbilical vein can become recanalised due to portal hypertension in patients with liver cirrhosis but the condition is rarely clinically significant. Although bleeding from this enlarged vein is a known complication, the finding of thrombophlebitis has not been previously described. Case report: We report the case of a 62-year-old male with a history of liver cirrhosis due to alcoholic liver disease presenting to hospital with epigastric pain. A CT scan of the patient’s abdomen revealed a thrombus with surrounding inflammatory changes in a recanalised umbilical vein. The patient was managed conservatively and was discharged home the following day. Conclusion: Thrombophlebitis of a recanalised umbilical vein is a rare cause of abdominal pain in patients with liver cirrhosis.


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