Infección por citomegalovirus en paciente inmunocompetente como causa de fiebre de origen desconocido. Reporte de caso

El citomegalovirus es un herpes virus cuya seroprevalencia mundial de infección oscila entre 45 al 100%.(1) En pacientes inmunocomprometidos es causante de enfermedades graves e incluso la muerte, no obstante, en pacientes inmunocompetentes la infección es poco común y suele presentarse de forma asintomática o con síntomas leves (2). Enfermedades con presentaciones clínicas infrecuentes, cuya principal manifestación es un síndrome febril y cuyo diagnóstico es difícil de determinar, suelen catalogarse como fiebres de origen desconocido, requiriendo de un abordaje diagnóstico adecuado para la correcta orientación clínica de su estudio. (3) Presentamos el caso de un paciente varón de 37 años sin comorbilidades, que cursa con fiebre de origen desconocido por un período de tres semanas. Durante su estancia hospitalaria, en búsqueda de un diagnóstico definitivo, se le realizan múltiples exámenes auxiliares tanto de laboratorio como imagenológicos como parte del protocolo de estudio de la fiebre de origen desconocido. Posteriormente en el noveno día de hospitalización considerando la clínica del paciente presencia de fiebre prolongada, faringitis, adenopatías cervicales, hepatoesplenomegalia y respaldándose en los resultados de los exámenes auxiliares como linfocitosis y aumento de transaminasas, se permite enfocar el diagnóstico en un síndrome mononucleósico, consecuentemente la detección serológica de anticuerpos IgM posibilitó realizar el diagnóstico definitivo de mononucleosis infecciosa por citomegalovirus. Es importante considerar al citomegalovirus como un agente etiológico primario de infección en pacientes inmunocompetentes que cursan con fiebre de origen desconocido, dicha consideración permitiría un mejor abordaje diagnóstico de esta patología, evitaría un tratamiento inicial inapropiado asociado a posibles complicaciones y se optimizaría el uso racional de herramientas clínicas auxiliares, empleando un mejor manejo de los recursos hospitalarios.Cytomegalovirus is a herpes virus whose worldwide seroprevalence of infection ranges from 45 to 100%. (1) In immunocompromised patients it is the cause of serious diseases and even death, however, in immunocompetent patients infection is rare and usually occurs asymptomatic or with mild symptoms (2). Common diseases with infrequent clinical presentations, whose main manifestation is a febrile syndrome and whose diagnosis is difficult to determine, are usually classified as fevers of unknown origin, requiring an adequate diagnostic approach for the correct clinical orientation of their study. (3) We present the case of a 37-year-old male patient without comorbidities, presenting with fever of unknown origin for a period of three weeks. During his hospital stay, in the search for a definitive diagnosis, multiple auxiliary laboratory and imaging tests are performed as part of the study protocol for fever of unknown origin. Later, on the ninth day of hospitalization, considering the patient's symptoms, the presence of prolonged fever, pharyngitis, cervical lymphadenopathy, hepatosplenomegaly and based on the results of auxiliary tests such as lymphocytosis and increased transaminases, it is allowed to focus the diagnosis on a mononucleosis syndrome, consequently serological detection of IgM antibodies made the definitive diagnosis of infectious cytomegalovirus mononucleosis. It is important to consider cytomegalovirus as a primary etiological agent of infection in immunocompetent patients with fever of unknown origin.This consideration will allow a better diagnostic approach to this pathology, avoid initial treatment associated with possible complications and optimize the rational use of tools auxiliary clinics, employing better management of hospital resources.Tesi

The Stieltjes--Fekete problem and degenerate orthogonal polynomials

A famous result of Stieltjes relates the zeroes of the classical orthogonal polynomials with the configurations of points on the line that minimize a suitable energy. The energy has logarithmic interactions and an external field whose exponential is related to the weight of the classical orthogonal polynomials. The optimal configuration satisfies an algebraic set of equations: we call this set of algebraic equations the Stieltjes--Fekete problem or equivalently the Stieltjes--Bethe equations. In this work we consider the Stieltjes-Fekete problem when the derivative of the external field is an arbitrary rational complex function. We show that its solutions are in one-to-one correspondence with the zeroes of certain non-hermitean orthogonal polynomials that satisfy an excess of orthogonality conditions and are thus termed "degenerate". This generalizes the original result of Stieltjes.Comment: 21 pages. V2: 24 pages; improved historical overview and added references. 5 figures. Slight generalization of the proof. V3: 26 pages; expanded scope of proof and added significant example. V4: 30 pages. Added details on primality assumption and other improvement

Exactly Solvable Anharmonic Oscillator, Degenerate Orthogonal Polynomials and Painlevé II

Using WKB analysis, the paper addresses a conjecture of Shapiro and Tater on the similarity between two sets of points in the complex plane; on one side is the set the values for which the spectrum of the quartic anharmonic oscillator in the complex planewith certain boundary conditions, has repeated eigenvalues. On the other side is the set of zeroes of the Vorob’ev–Yablonskii polynomials, i.e. the poles of rational solutions of the second Painlevé equation. Along the way, we indicate a surprising and deep connection between the anharmonic oscillator problem and certain degenerate orthogonal (monic) polynomials