A

Abstract:  Human Bocavirus-1/HBoV1 causes acute respiratory infections/ARI (bronchiolitis/pneumonia) mostly in young children. It was identified in 2005 and has not yet been incorporated into the routine virus screening in ARI. Symptoms of viral pneumonia in children less than 2 years old are often interpreted as of bacterial etiology, leading to unnecessary administration of antibiotics. Objective: to report the case of a previously healthy infant who developed HBoV1 pneumonia without complications, in order to consider HBoV1 as one of the possible agents involved. Clinical case. 19-month-old female, full-term/2780 grams. No relevant personal or familiar pathological history; complete vaccination. Reason for consultation: fever, cough, and shortness of breath. Antecedents: 3 days before, she started with rhinitis and dry cough. She had a fever peak of 38.7°C, so her pediatrician prescribed oral amoxicillin. On Apr/26/2021 she went to the emergency service due to persistent fever and worsening cough. Mild/moderate respiratory distress was observed; inhaled adrenergic drugs were administered, with good clinical response and outpatient follow-up (prior swabbing for COVID-19). The next day, she returned with food rejection and was hospitalized. Laboratory: hemoglobin 10.9g/dl, hematocrit 34%; leukocytes: 15,380 (69/15/15); platelets 299,000/ml; gases: 7.48/27.2/84.2/19.9/-2.1); ionogram Na 134/K 4/Cl 100; CRP: 17.8. Chest X-ray compatible with viral pneumonia. O2 saturation: 93%. Amoxicillin was suspended; hydration, oxygen by nasal cannula (3 liters/min) and inhaled salbutamol were administered. The complete panel of respiratory viruses was negative (RSV, Parainfluenza 1-3, Metapneumovirus, Influenza A/B and Adenovirus by IF; PCR for COVID-19: negative). HBoV1 detected in nasal secretions and serum (PCR with high viral load/>1x106 c.gen/mL) was the only positive finding. Evolution: 48 hours after admission she was afebrile; O2 saturation 95%; supplementary oxygen therapy was suspended. Patient was discharged without complications. In the follow-up (10 days) she did not show relapses or respiratory symptoms, so aerosol therapy was suspended. Conclusions. A case of HBoV1 infection in an infant with no comorbidity is reported. Recognition of the viral etiology in hospitalized cases of pneumonia contributes to optimize the clinical management of patients with rational use of antibiotics. HBoV1 should be included in the standard screening for respiratory infections in hospitalized infants.Resumen:  Bocavirus humano-1/HBoV1 es un parvovirus que causa infecciones respiratorias/IRA (bronquiolitis o neumonía) sobre todo en niños pequeños. Fue identificado en 2005 y aún no está incorporado a la pesquisa de virus habituales en IRA. Los cuadros de neumonía viral en menores de 2 años suelen interpretarse como de etiología bacteriana, administrándoles antibióticos innecesariamente. Objetivo: Reportar el caso de una lactante, sin comorbilidades previas, que desarrolla neumonía por HBoV1 sin complicaciones, a fin de considerar a este virus como uno más de los posibles agentes involucrados. Caso clínico. Paciente femenina de 19 meses de edad, nacida a término/2780gramos. Sin antecedentes patológicos, ni familiares relevantes; vacunación completa. MC: fiebre, tos y dificultad respiratoria. Antecedentes: 3 días previos inicia con rinitis y tos seca. Presenta un pico febril de 38,7°C por lo que su pediatra prescribió amoxicilina vía oral. El día 26/04/2021 concurre al servicio de emergencia por persistencia de la fiebre y empeoramiento de la tos. Se objetiva dificultad respiratoria leve/moderada; se administra adrenérgicos inhalados, con buena repuesta clínica y seguimiento ambulatorio (previo hisopado para COVID-19). Al día siguiente, ante el rechazo alimentario se decide internación. Laboratorio: Hemoglobina 10.9g/dl-Hto 34%; GB:15.380(69/15/15); plaquetas 299.000/ml; Gases:7.48/27.2/84.2/19.9/-2.1); Ionograma (Na134/K4/Cl100); PCR:17.8. Rx tórax compatible con neumonía viral. SatO2:93%. Se suspende amoxicilina, se administra hidratación, oxígeno por naricera-3litros/min y salbutamol inhalado. El panel completo de virus respiratorios resultó negativo (IFI para VRS, Parainfluenza 1,2,3, Metapneumovirus, Infuenza A y B y Adenovirus; PCR para COVID-19: negativo). Detección de HBoV1 en secreciones nasales y suero (PCR positiva con alta carga viral/>1x10^6c.gen/mL) fue el único hallazgo positivo. Evolución: a las 48 hs. del ingreso estaba afebril; Sat 95%; se suspende oxigenoterapia. Alta sin complicaciones. El seguimiento (hasta 10 días) no mostró recaídas o sintomatología respiratoria por lo que se suspende aerosolterapia. Conclusiones. Se reporta un caso de infección por BoVH1 en lactante sin comorbilidad previa. El reconocimiento de la etiología viral en los cuadros hospitalizados por neumonía contribuye a optimizar el manejo clínico de estos pacientes con uso más racional de antibióticos. La detección de BoVH1 debería ser parte de la pesquisa estándar para infecciones respiratorias en lactantes hospitalizados

Hidropesía y muerte fetal intraútero asociada a infección por parvovirus B19. Reporte de un caso

Human parvovirus B19/B19V infection in pregnant women can be transmitted to the fetus and cause anemia, hydrops and fetal death in situations that are still poorly understood. Its clinical suspicion is important to request opportune studies in the mother and the fetus that can confirm the diagnosis (specific antibodies and viral DNA). A fatal case of hydrops fetalis associated with B19V infection is reported. A 40-year-old patient with a controlled pregnancy (30 weeks of gestation). Consultation for not perceiving fetal movements. History of rheumatoid arthritis in remission (without treatment during pregnancy) and previous abortion (attributed to cytomegalovirus); receives alpha-methyldopa for pregnancy-induced hypertension with good evolution. Family history of systemic lupus erythematosus and scleroderma. She did not report rashes or previous parvoviral symptoms. Blood group 0 Rh+. Physical examination: blood pressure/BP 140-90mmHg, afebrile. Negative uterine dynamics (10 minutes), negative fetal heartbeat (doppler), closed cervix, intact amniotic membranes, negative genitorrhagia. Ultrasound: "single fetus died in utero, with pleural effusion, ascites and hydropic signs". A cesarean section was performed extracting a dead male fetus, with signs of maceration, weighing 1500g. Postoperative with good evolution. Discharge with analgesia and controls by obstetrics office, medical clinic and rheumatology. Pathological anatomy: "900g placenta, edematous chorionic villi, decreased villous capillaries with signs of moderate obliterative endarteritis; generalized edema attributable to hydrops." negative genetics. Maternal serum studies (2 months post-cesarean): indeterminate IgM-B19V=24.8IU/mL(cutoff/25), positive IgG-B19>50IU/mL(cutoff/3), positive PCR/B19V (limit detection) . Other negative TORCH results. IgM-CMV negative, IgG-CMV positive=709.5AU/mL(cutoff/6). In placenta: PCR/B19V negative. A case of hydrops with fetal death related to B19V is reported. The timely collection of samples could improve the efficiency of diagnostic methods and the interpretation of results in cases of such great impact on health.La infección por parvovirus humano B19/B19V en la embarazada puede transmitirse al feto y provocar anemia, hidropesía y muerte fetal en situaciones aún poco conocidas. Su sospecha clínica es importante para solicitar estudios oportunos en la madre y el feto que puedan confirmar el diagnóstico (anticuerpos específicos y ADN viral). Se reporta un caso fatal de hidropesía fetal asociado a infección por B19V.  Paciente de 40 años con embarazo controlado (30 semanas de gestación). Consulta por no percibir movimientos fetales. Antecedente de artritis reumatoidea en remisión (sin tratamiento durante el embarazo) y aborto previo (atribuido a citomegalovirus); recibe alfa-metildopa por hipertensión-inducida-embarazo con buena evolución. Antecedentes familiares de lupus eritematoso sistémico y esclerodermia. No refiere exantemas o sintomatología parvoviral previa. Grupo sanguíneo 0 Rh+. Examen físico: tensión arterial/TA 140-90mmHg, afebril. Dinámica uterina negativa (10 minutos), latidos cardiacos fetales negativos (doppler), cérvix cerrado, membranas amnióticas íntegras, genitorragia negativa. Ecografía: "feto único muerto in útero, con derrame pleural, ascitis y signos hidrópicos”. Se realiza operación cesárea extrayendo feto masculino muerto, con signos de maceración, peso 1500g. Postoperatorio con buena evolución. Alta con analgesia y controles por consultorio de obstetricia, clínica médica y reumatología. Anatomía patológica: "placenta de 900g, vellosidades coriales edematosas, disminución de capilares vellosos con signos de endarteritis obliterativa moderada; edema generalizado atribuible a hidropesía". Genética negativa. Estudios en suero materno (2 meses post-cesárea): IgM-B19V indeterminado=24,8UI/mL(cutoff/25), IgG-B19 positiva>50UI/mL(cutoff/3), PCR/B19V positiva (límite detección). Resto de resultados TORCH negativos. IgM-CMV negativa, IgG-CMV positiva=709,5UA/mL(cutoff/6). En placenta: PCR/B19V negativa.  Se reporta un caso de hidropesía con muerte fetal relacionada a B19V. La obtención oportuna de muestras podría mejorar la eficiencia de los métodos diagnósticos y la interpretación de resultados en casos de tanto impacto para la salud. &nbsp

Reporte de un caso de Hidropesía fetal no inmune. Importancia de la pesquisa de Infección por Parvovirus B19 en embarazadas para un diagnóstico oportuno

Abstract:  Hydropsfetalis (HF) occurs in 1/600 pregnancies. With the introduction of Rhesus-immunoprophylaxis, only 50% are caused by Rh-hemolytic disease. Non-immunological causes are heart defects, chromosomal abnormalities, twin-twin transfusion syndrome, or infections by Parvovirus B19/B19V, among others. B19V can infect susceptible pregnant women causing a wide variety of conditions, including hydrops (with anemia, heart failure and/or fetal-neonatal death). Objective: to report a case of non-immune HF with B19V as the possible etiology, in order to highlight the importance of its investigation in the pregnant woman. Clinical case. Para2 gravida3 patient, 32 yr.old, 33.5 weeks gestation/wg, derived from a town in the Province of Córdoba with a probable diagnosis of Rh isoimmunization. She was admitted to the Hospital Universitario de Marternidad y Neonatología/HUMN presenting anemia, threat of preterm labor, and a hydropic fetus on ultrasound. Uterus-inhibition and fetal lung maturation were initiated. The patient did not report fever or other parvoviral symptoms. Laboratory: hemoglobin 7.6 g/dl, hematocrit 22%. Ultrasound control showed fetal right hydrothorax, polyhydramnios and fetal bradycardia, thus a cesarean section was decided and a baby male was born. The patient evolved favorably during the puerperium. Placenta biopsy: chorio-amnionitis. Newborn was premature/34 wg, large for gestational age/3200gr. Apgar score 1/1/3. He presented generalized edema, hydrothorax and ascites. He was admitted to Neonatal Intensive Care Unit in a serious general condition: hemodynamic- hepatic- and renal- compromise, multi-factorial jaundice. Drains and transfusions were performed and mechanical ventilation was required. Supplementaloxygenwaswithdrawn at 40 days. Discharge at 50 days. Studies: Mother 0(Rh-), newborn 0(Rh+); Coombs test: negative. Only anti-B19V IgG was found in the mother (11.6 IU/ml).  Other infections such as syphilis, toxoplasmosis, Chagas (T.cruzi), cytomegalovirus, Hepatitis B/C, and HIV were discarded by serology. Newborn: B19V IgM and DNA were negative. Conclusions: a case of non-immune hydropsfetalis with a probable diagnosis of B19V infection is reported. The interpretation of laboratory results (serology/DNA) for the diagnosis of vertical infection is complex, depending on which/when clinical samples are obtained. It is important to consider screening of B19V infection in pregnant women in order to optimize the diagnosis of non-immune hydropsfetalis.Resumen:  La hidropesía fetal (HF) ocurre en 1c/600 embarazos. Con la introducción de la Inmunoprofilaxis con Rhesus, solo el 50% son causados por enfermedad hemolítica-Rh. Existen causas no inmunológicas como: defectos cardiacos, anomalías cromosómicas, síndrome de transfusión gemelo-gemelo, o infecciones como Parvovirus B19 (B19V), entre otras. Parvovirus B19 (B19V) puede infectar embarazadas susceptibles ocasionando cuadros muy variados, entre ellos Hidropesía (con anemia, insuficiencia cardíaca y/o muerte feto-neonatal). Objetivo: reportar un caso de HF no inmune de posible etiología por B19V a fin de resaltar la importancia de su pesquisa oportuna en embarazadas. Caso clínico. Paciente tercigesta secundípara, de 32 años, embarazo de 33.5 semanas. Derivada del interior de Córdoba con diagnóstico probable de isoinmunización Rh. Presenta anemia, amenaza de parto prematuro, y feto hidrópico por ecografía. Ingresa al Hospital Universitario Materno Neonatal/HUMN; se inicia útero-inhibición y maduración pulmonar fetal. No refiere fiebre o síntomas parvovirales. Laboratorio: Hb:7,6 g/dl. Hto:22%. Control ecográfico: Hidrotórax fetal derecho, polihidramnios. Se constata bradicardia fetal (signos de falta de bienestar fetal) por lo que se decide finalización por operación cesárea de un recién nacido masculino. La paciente evoluciona su puerperio favorablemente. Biopsia de placenta: corio-amnionitis. Recién Nacido Prematuro/34 semanas, Grande para Edad Gestacional/3200gr. Apgar: 1/1/3. Presenta edema generalizado, hidrotórax y ascitis. Ingresa a Terapia Intensiva Neonatal en grave estado general: compromiso hemodinámico, hepático, renal e ictericia multifactorial. Se realizan drenajes y transfusiones. Requirió de ventilación mecánica; a los 40 días se retira oxigeno suplementario, alta a los 50 días. Estudios: Madre O (Rh-), RN O (Rh+); prueba de Coombs Negativa (no sensibilizada). Sólo se encuentra IgG positiva para B19V (madre y RN); IgM y ADN negativos. Serología para Hepatitis B-C, HIV, VDRL, Toxoplasmosis, Chagas, CMV, negativos. Conclusiones: se reporta un caso de hidropesía fetal no inmune con diagnóstico probable de infección por B19V.  La interpretación de los resultados de laboratorio (serología y ADN) para el diagnóstico de infección vertical es compleja dependiendo, además, del momento de toma de las muestras. Sería importante considerar a la pesquisa de infección por B19V en las embarazadas a fin de optimizar el diagnóstico de hidropesía fetal no inmune

The effect of transcranial direct current stimulation of the motor cortex on exercise-induced pain

Purpose: Transcranial direct current stimulation (tDCS) provides a new exciting means to investigate the role of the brain during exercise. However, this technique is not widely used in exercise science, with little known regarding effective electrode montages. This study investigated whether tDCS of the motor cortex (M1) would elicit an analgesic response to exercise-induced pain (EIP). Methods: Nine participants completed a VO2max test and three time to exhaustion (TTE) tasks on separate days following either 10 min 2 mA tDCS of the M1, a sham or a control. Additionally, seven participants completed 3 cold pressor tests (CPT) following the same experimental conditions (tDCS, SHAM, CON). Using a well-established tDCS protocol, tDCS was delivered by placing the anodal electrode above the left M1 with the cathodal electrode above dorsolateral right prefrontal cortex. Gas exchange, blood lactate, EIP and ratings of perceived exertion (RPE) were monitored during the TTE test. Perceived pain was recorded during the CPT. Results: During the TTE, no significant differences in time to exhaustion, RPE or EIP were found between conditions. However, during the CPT, perceived pain was significantly (P < 0.05) reduced in the tDCS condition (7.4 ± 1.2) compared with both the CON (8.6 ± 1.0) and SHAM (8.4 ± 1.3) conditions. Conclusion: These findings demonstrate that stimulation of the M1 using tDCS does not induce analgesia during exercise, suggesting that the processing of pain produced via classic measures of experimental pain (i.e., a CPT) is different to that of EIP. These results provide important methodological advancement in developing the use of tDCS in exercise