Coxiella/Fiebre Q

Características Generales de Coxiella

Características generales de Coxiella

• Organismos Gram-negativos
• Bastones pleomórficos
• Intracelular obligada
• Aerobia
• Anteriormente designada como Rickettsia Rickettsia Rickettsiae are a diverse collection of obligate intracellular, gram-negative bacteria that have a tropism for vascular endothelial cells. The vectors for transmission vary by species but include ticks, fleas, mites, and lice. Rickettsia
• Clasificada como Gammaproteobacteria Gammaproteobacteria A group of the proteobacteria comprised of facultatively anaerobic and fermentative gram-negative bacteria. Coxiella/Q Fever

Especies clínicamente relevantes

Coxiella burnetii Coxiella burnetii A species of gram-negative bacteria that grows preferentially in the vacuoles of the host cell. It is the etiological agent of q fever. Coxiella/Q Fever causa la fiebre Q.

Epidemiología y Patogénesis

Epidemiología

• Distribución geográfica:
  • Se encuentra a nivel mundial, excepto en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Nueva Zelanda
  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria Estados Unidos, la incidencia más alta se encuentra en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el Medio Oeste y California.
  • Más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las zonas rurales
• Más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum hombres que en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum mujeres
• Más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum adultos que en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños
• Mayor incidencia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum primavera y verano

Reservorio

• Garrapatas (reservorio principal)
• Mamíferos (incluyendo animales de granja y mascotas)
• Aves

Vías de transmisión

• Inhalación de aerosoles
• Consumo de leche contaminada/ productos lácteos no pasteurizados
• Inoculación intradérmica
• Transfusión sanguínea
• Transplacentario (madre a feto)

Factores de riesgo del huésped

• Contacto con animales de granja:
  • Agricultores
  • Trabajadores del matadero
  • Personal veterinario
  • Pastores
• Individuos que viven cerca de granjas
• Trabajadores de laboratorio

Factores de virulencia

Variación de fase antigénica:

• Fase I:
  • Altamente infecciosa
  • Contiene lipopolisacárido liso
  • Protege contra los LOS Neisseria mecanismos de defensa del huésped
• Fase II:
  • No infecciosa
  • Contiene lipopolisacárido rugoso (carece de azúcares del antígeno O terminal)

Variantes morfológicas:

• Variante de células pequeñas:
  • Apariencia de esporas
  • Metabólicamente inactiva
  • Resistente al AL Amyloidosis estrés ambiental:
    • Calor Calor Inflammation
    • Desecación
    • Químicos
    • Presión
• Variante de células grandes:
  • Metabólicamente activa
  • Capaz de replicarse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum fagolisosomas

Escape de muerte intracelular:

• Inhibición de la fusión de catepsina
• Producción de superóxido dismutasa

Fisiopatología

• El organismo es más comúnmente inhalado (variante de células pequeñas que persiste en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum fómites)→ fagocitado por macrófagos alveolares
• Acidificación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum fagolisosoma → transformación de C. burnetii a su estado metabólicamente activo (variante de células grandes)
• Replicación dentro del fagolisosoma→ ruptura de la célula huésped → los LOS Neisseria organismos se diseminan sistémicamente, especialmente al AL Amyloidosis sistema reticuloendotelial (hígado, bazo y médula ósea)
• La respuesta inmune da como resultado granulomas Granulomas A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. Sarcoidosis no necrotizantes.
• Puede ocurrir la producción de autoanticuerpos.

Presentación Clínica

Los LOS Neisseria pacientes pueden presentar una amplia gama de síntomas que varían en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum gravedad, desde asintomáticos hasta enfermedad severa.

Fiebre Q aguda

El período de incubación de la infección aguda es de aproximadamente 20 días. Los LOS Neisseria pacientes pueden presentar cualquiera de las siguientes afecciones:

• Enfermedad asintomática
• Enfermedad similar a la gripe (dura entre 1–3 semanas):
  • Inicio abrupto de fiebre alta
  • Fatiga
  • Cefalea con fotofobia
  • Mialgias
  • Anorexia Anorexia The lack or loss of appetite accompanied by an aversion to food and the inability to eat. It is the defining characteristic of the disorder anorexia nervosa. Anorexia Nervosa
• Neumonía (dura entre 10–90 días):
  • Fiebre
  • Tos TOS Thoracic outlet syndrome (TOS) is a broad term used for a spectrum of syndromes related to the general region of the thoracic outlet, which involves the compression or irritation of elements of the brachial plexus, subclavian artery, or subclavian vein. Thoracic Outlet Syndrome no productiva
  • Dificultad respiratoria aguda
  • Dolor Dolor Inflammation torácico pleurítico
• Hepatitis (granulomatosa):
  • Fiebre
  • Hepatomegalia
  • Dolor Dolor Inflammation abdominal del cuadrante superior derecho
  • Náuseas y vómitos
  • Diarrea
  • Transaminitis Transaminitis Tick-borne Encephalitis Virus
• Afectación cardíaca:
  • Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis aguda (autoinmune)
  • Pericarditis Pericarditis Pericarditis is an inflammation of the pericardium, often with fluid accumulation. It can be caused by infection (often viral), myocardial infarction, drugs, malignancies, metabolic disorders, autoimmune disorders, or trauma. Acute, subacute, and chronic forms exist. Pericarditis
  • Miocarditis
• Afectación neurológica:
  • Meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis aséptica
  • Encefalitis
  • Neuropatía periférica

Fiebre Q crónica

La infección crónica puede manifestarse meses o años después de una infección aguda.

• Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis (cultivo negativo) es la manifestación crónica más común:
  • Fiebre leve
  • Sudoración nocturna
  • Fatiga
  • Disnea
  • Tromboembolismo séptico
  • Insuficiencia cardíaca
• Derrame pericárdico
• Hepatitis crónica
• Osteomielitis
• Artritis séptica
• Mononeuritis
• Fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans intersticial
• Pseudotumores
• Glomerulonefritis

Complicaciones

La fiebre Q en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el embarazo se asocia con:

• Aborto espontáneo
• Restricción del crecimiento fetal intrauterino
• Parto prematuro

Diagnóstico

La fiebre Q carece de una presentación clínica distintiva; por lo tanto, el diagnóstico se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un alto índice de sospecha basado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria factores de riesgo del paciente.

Estudios de laboratorio

Pruebas de diagnóstico:

• Inmunofluorescencia indirecta para inmunoglobulina G ( IgG IgG The major immunoglobulin isotype class in normal human serum. There are several isotype subclasses of igg, for example, igg1, igg2a, and igg2b. Hypersensitivity Pneumonitis) e inmunoglobulina M ( IgM IgM A class of immunoglobulin bearing mu chains (immunoglobulin mu-chains). Igm can fix complement. The name comes from its high molecular weight and originally being called a macroglobulin. Immunoglobulins: Types and Functions)(alta sensibilidad y especificidad)
• PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR) para detectar ácido desoxirribonucleico (ADN) de C. burnetii
• Cultivos:
  • No crece en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cultivos rutinarios
  • Requiere contención especial de bioseguridad debido a su infectividad

Evaluación de soporte:

• Recuento normal de leucocitos (90% de los LOS Neisseria casos)
• Trombocitopenia
• ↑ Alanina aminotransferasa ( ALT ALT An enzyme that catalyzes the conversion of l-alanine and 2-oxoglutarate to pyruvate and l-glutamate. Liver Function Tests) y aspartato aminotransferasa ( AST AST Enzymes of the transferase class that catalyze the conversion of l-aspartate and 2-ketoglutarate to oxaloacetate and l-glutamate. Liver Function Tests) → hepatitis
• Autoanticuerpos asociados:
  • Anticuerpos antifosfolípidos
  • Anticoagulante lúpico
• Biopsia hepática → cambios granulomatosos

Imagenología

• Radiografía de tórax: consolidación, derrame pleural → neumonía
• Ecocardiografía: vegetación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum una válvula cardíaca → endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis
• Ultrasonido: hepatomegalia → hepatitis granulomatosa

Tratamiento y Prevención

Tratamiento

La terapia con antibióticos incluye:

• Doxiciclina (preferida)
• Trimetoprim-sulfametoxazol
  • Medicamento de eelcción en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes embarazadas
  • Adminsitrada hasta el final del 7mo mes (evitando los LOS Neisseria riesgos perinatales cerca del parto)
  • Ingerido con ácido fólico durante el primer trimestre
• Claritromicina
• Fluoroquinolonas
• Se puede agregar hidroxicloroquina a la doxiciclina en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con:
  • Compromiso cardiovascular
    • Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis: 18 meses
    • Infección vascular (e.g., injerto vascular): 24 meses
  • Fiebre Q crónica

Prevención

• Vacunas humanas:
  • Recomendadas para personas con riesgo laboral
  • Contraindicadas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum personas previamente expuestas
• Vacunas animales para reducir la diseminación bacteriana
• Eliminación adecuada de la placenta Placenta A highly vascularized mammalian fetal-maternal organ and major site of transport of oxygen, nutrients, and fetal waste products. It includes a fetal portion (chorionic villi) derived from trophoblasts and a maternal portion (decidua) derived from the uterine endometrium. The placenta produces an array of steroid, protein and peptide hormones (placental hormones). Placenta, Umbilical Cord, and Amniotic Cavity y los LOS Neisseria productos del parto
• Evitar productos lácteos sin pasteurizar
• Pruebas de rutina de animales
• Cuarentena para animales importados

Comparación con Gammaproteobacterias Similares

Diagnóstico Diferencial

• Enfermedad de Lyme: una infección causada por Borrelia burgdorferi Borrelia burgdorferi A specific species of bacteria, part of the borrelia burgdorferi group, whose common name is lyme disease spirochete. Borrelia, que es transmitida por la garrapata Ixodes. La presentación depende de la etapa de la enfermedad y puede incluir una erupción característica de eritema migratorio. Por lo general, no se observa una erupción en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la fiebre Q. Las manifestaciones neurológicas, cardíacas, oculares y articulares también son comunes en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum etapas posteriores. El diagnóstico se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria hallazgos clínicos y la exposición a las garrapatas, y está respaldado por pruebas serológicas. Para el tratamiento se utilizan antibióticos, como doxiciclina y ceftriaxona.
• Fiebre maculosa de las Montañas Rocosas: una enfermedad transmitida por garrapatas causada por Rickettsia rickettsii Rickettsia rickettsii A species of gram-negative, aerobic bacteria that is the etiologic agent of rocky mountain spotted fever. Its cells are slightly smaller and more uniform in size than those of rickettsia prowazekii. Rickettsia. Los LOS Neisseria pacientes presentan una tríada clásica de fiebre, cefalea y erupción. Una erupción generalmente no está presente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la fiebre Q. Otros síntomas incluyen malestar general, malestar gastrointestinal y síntomas neurológicos de confusión, letargo y estupor. El diagnóstico se realiza con base en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las características clínicas, biopsia de la erupción cutánea y pruebas serológicas. El tratamiento involucra antibióticos, generalmente doxiciclina.
• Erliquiosis y anaplasmosis Anaplasmosis Anaplasmosis is a tick-borne bacterial infection. The most common causative species include Anaplasma phagocytophilum, which infect and multiply within granulocytes. The clinical presentation can vary widely, but often includes fever, malaise, headache, myalgia, and arthralgias. Ehrlichiosis and Anaplasmosis: infecciones transmitidas por garrapatas causadas por Ehrlichia chaffeensis Ehrlichia chaffeensis A species of gram-negative bacteria that is the causative agent of human ehrlichiosis. This organism was first discovered at fort chaffee, arkansas, when blood samples from suspected human ehrlichiosis patients were studied. Ehrlichiosis and Anaplasmosis y Anaplasma phagocytophilum Anaplasma phagocytophilum A species of gram-negative bacteria in the genus anaplasma, family anaplasmataceae, formerly called ehrlichia phagocytophila or ehrlichia equi. This organism is tick-borne (ixodes) and causes disease in horses and sheep. In humans, it causes human granulocytic ehrlichiosis. Ehrlichiosis and Anaplasmosis, respectivamente. Los LOS Neisseria síntomas incluyen fiebre, cefalea y malestar general. Una erupción es poco común, pero pueden ocurrir erupciones petequiales o maculopapulares. El diagnóstico se realiza mediante PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR), que diferencia estas enfermedades de la fiebre Q. El tratamiento de ambas enfermedades es con doxiciclina.
• Babesiosis Babesiosis Babesiosis is an infection caused by a protozoa belonging to the genus, Babesia. The most common Babesia seen in the United States is B. microti, which is transmitted by the Ixodes tick. The protozoa thrive and replicate within host erythrocytes. Lysis of erythrocytes and the body’s immune response result in clinical symptoms. Babesia/Babesiosis: una infección transmitida por garrapatas causada por Babesia Babesia Babesiosis is an infection caused by a protozoa belonging to the genus, Babesia. The most common Babesia seen in the United States is B. microti, which is transmitted by the Ixodes tick. The protozoa thrive and replicate within host erythrocytes. Lysis of erythrocytes and the body’s immune response result in clinical symptoms. Babesia/Babesiosis. Los LOS Neisseria pacientes pueden ser asintomáticos o desarrollar fiebre, fatiga, malestar general y artralgias. Los LOS Neisseria pacientes asplénicos, inmunocomprometidos y de edad avanzada corren el riesgo de sufrir una enfermedad grave que provoca anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica, trombocitopenia, hepatoesplenomegalia, insuficiencia renal y muerte. El diagnóstico se confirma con un frotis de sangre periférica, pruebas serológicas y PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR). El tratamiento incluye antibióticos, como atovacuona más azitromicina.
• Brucelosis: una infección zoonótica causada por varias especies de Brucella Brucella Brucellosis (also known as undulant fever, Mediterranean fever, or Malta fever) is a zoonotic infection that spreads predominantly through ingestion of unpasteurized dairy products or direct contact with infected animal products. Clinical manifestations include fever, arthralgias, malaise, lymphadenopathy, and hepatosplenomegaly. Brucella/Brucellosis que se propaga predominantemente por ingestión o contacto directo con productos animales infectados. Las manifestaciones clínicas incluyen fiebre, artralgias, malestar general, linfadenopatía y hepatoesplenomegalia. Los LOS Neisseria datos de antecedentes, presentación, serología y cultivo se utilizan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el diagnóstico. La brucelosis se puede diferenciar de la fiebre Q según la serología. El tratamiento implica una combinación de antibióticos, que incluyen doxiciclina, rifampicina y aminoglucósidos.
• Mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis infecciosa: enfermedad causada por el virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de Epstein-Barr, que se caracteriza por fiebre, fatiga, linfadenopatía y faringitis. El diagnóstico se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las características clínicas y las pruebas, que incluyen una prueba de anticuerpos heterófilos o serología. La presentación clínica y la serología ayudan a diferenciar la mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis de la fiebre Q. El tratamiento es de soporte.
• Hepatitis viral: inflamación del hígado causada por el virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de la hepatitis. Los LOS Neisseria pacientes pueden presentar un pródromo viral de fiebre, anorexia Anorexia The lack or loss of appetite accompanied by an aversion to food and the inability to eat. It is the defining characteristic of the disorder anorexia nervosa. Anorexia Nervosa y náuseas. También puede ocurrir dolor Dolor Inflammation abdominal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cuadrante superior derecho, ictericia y transaminitis Transaminitis Tick-borne Encephalitis Virus. El diagnóstico se realiza con base en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pruebas serológicas virales, que ayudan a diferenciar la hepatitis viral de la fiebre Q. El tratamiento de la hepatitis aguda es de soporte.