Norovirus

Clasificación

Características Generales y Epidemiología

Características básicas del norovirus Norovirus Norovirus is a nonenveloped, single-stranded, positive-sense RNA virus belonging to the Caliciviridae family. Norovirus infections are transmitted via the fecal-oral route or by aerosols from vomiting. The virus is one of the most common causes of nonbacterial gastroenteritis epidemic worldwide. Symptoms include watery and nonbloody diarrhea, nausea, vomiting, and low-grade fever. Norovirus humano

También conocido como 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 Norwalk

• Taxonomía:
  • Familia: Caliciviridae Caliciviridae A family of RNA viruses infecting a broad range of animals. Most individual species are restricted to their natural hosts. They possess a characteristic six-pointed starlike shape whose surfaces have cup-shaped (chalice) indentions. Transmission is by contaminated food, water, fomites, and occasionally aerosolization of secretions. Genera include lagovirus; norwalk-like viruses; sapporo-like viruses; and vesivirus. Norovirus
  • Género: Norovirus Norovirus Norovirus is a nonenveloped, single-stranded, positive-sense RNA virus belonging to the Caliciviridae family. Norovirus infections are transmitted via the fecal-oral route or by aerosols from vomiting. The virus is one of the most common causes of nonbacterial gastroenteritis epidemic worldwide. Symptoms include watery and nonbloody diarrhea, nausea, vomiting, and low-grade fever. Norovirus
• 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 ARN:
  • Monocatenario
  • Sentido positivo
  • Lineal
  • No segmentado
• Estructura:
  • Simetría icosaédrica
  • No envuelto
  • Cápside proteica
• Muy estable 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 ambiente y resistente a:
  • Congelación
  • Temperaturas hasta 60°C (140°F)
  • Alcohol
  • Ácido
  • Cloro

Especies clínicamente relevantes

La enfermedad humana es causada principalmente por los LOS Neisseria genogrupos GI y GII.

Enfermedades asociadas

Norovirus Norovirus Norovirus is a nonenveloped, single-stranded, positive-sense RNA virus belonging to the Caliciviridae family. Norovirus infections are transmitted via the fecal-oral route or by aerosols from vomiting. The virus is one of the most common causes of nonbacterial gastroenteritis epidemic worldwide. Symptoms include watery and nonbloody diarrhea, nausea, vomiting, and low-grade fever. Norovirus es una de las principales causas de gastroenteritis Gastroenteritis Gastroenteritis is inflammation of the stomach and intestines, commonly caused by infections from bacteria, viruses, or parasites. Transmission may be foodborne, fecal-oral, or through animal contact. Common clinical features include abdominal pain, diarrhea, vomiting, fever, and dehydration. Gastroenteritis.

Epidemiología

• Responsable del 60% de los LOS Neisseria casos de gastroenteritis Gastroenteritis Gastroenteritis is inflammation of the stomach and intestines, commonly caused by infections from bacteria, viruses, or parasites. Transmission may be foodborne, fecal-oral, or through animal contact. Common clinical features include abdominal pain, diarrhea, vomiting, fever, and dehydration. Gastroenteritis aguda 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
• Incidencia:
  • Estados Unidos: 21 millones de casos anuales
  • A nivel mundial: 685 millones de casos al AL Amyloidosis año
• Mayor prevalencia 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 países 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 vía de desarrollo
• Demografía:
  • Ocurre 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 todos los LOS Neisseria grupos de edad
  • Sin predilección por sexo
  • Sin predilección por raza
• Mortalidad:
  • Estados Unidos: 800 muertes al AL Amyloidosis año (principalmente niños pequeños y ancianos)
  • A nivel mundial: aproximadamente 50 000 muertes al AL Amyloidosis año (principalmente 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 países 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 vía de desarrollo)
• Los LOS Neisseria brotes 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:
  • Hospitales
  • Cruceros
  • Escuelas
  • Residencias de ancianos
  • Bases Bases Usually a hydroxide of lithium, sodium, potassium, rubidium or cesium, but also the carbonates of these metals, ammonia, and the amines. Acid-Base Balance militares

Patogénesis

Reservorio

Los LOS Neisseria seres humanos son el único reservorio conocido para norovirus Norovirus Norovirus is a nonenveloped, single-stranded, positive-sense RNA virus belonging to the Caliciviridae family. Norovirus infections are transmitted via the fecal-oral route or by aerosols from vomiting. The virus is one of the most common causes of nonbacterial gastroenteritis epidemic worldwide. Symptoms include watery and nonbloody diarrhea, nausea, vomiting, and low-grade fever. Norovirus humano.

Transmisión

Esta enfermedad altamente virulenta es transmitida por:

• Vía fecal-oral (alimentos, agua o superficies/fómites contaminados)
• Aerosoles (a menudo por vómitos)

Factores de riesgo del huésped

Los LOS Neisseria siguientes grupos tienen tasas más altas de infección y/o complicaciones graves:

• Neonatos
• Ancianos
• Pacientes inmunocomprometidos

Fisiopatología

• El mecanismo no se entiende 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 su totalidad.
• 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 puede ingresar a un huésped humano a través de:
  • Enterocitos
  • Células M
• 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 se replica 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 macrófagos, células dendríticas y células B.
• La enfermedad está asociada con:
  • Retraso 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 vaciamiento gástrico → náuseas y vómitos
  • ↓ Actividad enzimática del borde 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 cepillo → diarrea malabsortiva
• Los LOS Neisseria viriones se liberan 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 heces.

Patología

La gastroenteritis Gastroenteritis Gastroenteritis is inflammation of the stomach and intestines, commonly caused by infections from bacteria, viruses, or parasites. Transmission may be foodborne, fecal-oral, or through animal contact. Common clinical features include abdominal pain, diarrhea, vomiting, fever, and dehydration. Gastroenteritis por norovirus Norovirus Norovirus is a nonenveloped, single-stranded, positive-sense RNA virus belonging to the Caliciviridae family. Norovirus infections are transmitted via the fecal-oral route or by aerosols from vomiting. The virus is one of the most common causes of nonbacterial gastroenteritis epidemic worldwide. Symptoms include watery and nonbloody diarrhea, nausea, vomiting, and low-grade fever. Norovirus se asocia con los LOS Neisseria siguientes hallazgos reversibles:

• La biopsia yeyunal muestra acortamiento de las microvellosidades, pero por lo demás la mucosa está intacta.
• Se observa vacuolización citoplasmática junto con infiltrados mononucleares de tejido.

Presentación Clínica

Cronología:

• Periodo de incubación: 12‒60 horas
• Duración de los LOS Neisseria síntomas: 1‒3 días

Los LOS Neisseria síntomas comunes incluyen:

• Náuseas y vómitos (más prominentes 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 las otras causas de gastroenteritis Gastroenteritis Gastroenteritis is inflammation of the stomach and intestines, commonly caused by infections from bacteria, viruses, or parasites. Transmission may be foodborne, fecal-oral, or through animal contact. Common clinical features include abdominal pain, diarrhea, vomiting, fever, and dehydration. Gastroenteritis)
• Diarrea
  • Acuosa
  • No sanguinolenta
• Cólico abdominal
• Fiebre
• Malestar
• Mialgias
• Cefalea

Manifestaciones severas:

• Deshidratación
  • Taquicardia
  • Hipotensión ortostática
  • Membranas mucosas secas
  • ↓ Turgencia de la piel
• Síntomas neurológicos (más 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 niños pequeños)
  • Convulsiones
  • Encefalopatía
• Diarrea crónica (llevando a emaciación) que afecta a individuos inmunocomprometidos con:
  • Leucemia
  • Linfoma
  • Trasplante (órganos sólidos o células hematopoyéticas)
  • Enfermedad de injerto contra el huésped

Diagnóstico y Tratamiento

Diagnóstico

El diagnóstico suele ser presuntivo y las pruebas de diagnóstico no suelen ser necesarias. Sin embargo, se pueden realizar pruebas de confirmación para personas inmunocomprometidas o con síntomas graves:

• Reacción 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 cadena de polimerasa ( 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), por sus siglas 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 inglés) para ARN viral 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 heces
  • Método de elección
  • Puede estar limitado por una carga viral baja
• Detección de antígenos por inmunoensayo enzimático
  • Utilidad limitada
  • Menor sensibilidad y especificidad que la 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)

Tratamiento

• El tratamiento es de soporte.
• Hidratación oral o intravenosa

Prevención

• Lavado de manos (agua y jabón, no desinfectantes a base de alcohol).
• Limpieza de superficies.
• Usar equipo de protección personal al AL Amyloidosis manipular heces o emesis de personas infectadas.
• Las personas sintomáticas deben:
  • Quedarse 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 casa y no asistir al AL Amyloidosis trabajo, la escuela o las guarderías
  • No manipular ni preparar alimentos para otros

Comparación de Calicivirus Similares

La siguiente tabla compara 2 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 muy similares dentro de la familia Caliciviridae Caliciviridae A family of RNA viruses infecting a broad range of animals. Most individual species are restricted to their natural hosts. They possess a characteristic six-pointed starlike shape whose surfaces have cup-shaped (chalice) indentions. Transmission is by contaminated food, water, fomites, and occasionally aerosolization of secretions. Genera include lagovirus; norwalk-like viruses; sapporo-like viruses; and vesivirus. Norovirus:

Diagnóstico Diferencial

• Rotavirus Rotavirus A genus of Reoviridae, causing acute gastroenteritis in birds and mammals, including humans. Transmission is horizontal and by environmental contamination. Seven species (rotaviruses A through G) are recognized. Rotavirus: un 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 ARN bicatenario no envuelto. La transmisión se produce por vía fecal-oral. El rotavirus Rotavirus A genus of Reoviridae, causing acute gastroenteritis in birds and mammals, including humans. Transmission is horizontal and by environmental contamination. Seven species (rotaviruses A through G) are recognized. Rotavirus es una causa frecuente de gastroenteritis Gastroenteritis Gastroenteritis is inflammation of the stomach and intestines, commonly caused by infections from bacteria, viruses, or parasites. Transmission may be foodborne, fecal-oral, or through animal contact. Common clinical features include abdominal pain, diarrhea, vomiting, fever, and dehydration. Gastroenteritis grave 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. Los LOS Neisseria casos severos pueden resultar 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 deshidratación y muerte. Por lo general, no se requieren pruebas de diagnóstico, pero 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 se puede detectar 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 muestras de heces mediante ensayo inmunoabsorbente ligado a enzimas ( ELISA ELISA An immunoassay utilizing an antibody labeled with an enzyme marker such as horseradish peroxidase. While either the enzyme or the antibody is bound to an immunosorbent substrate, they both retain their biologic activity; the change in enzyme activity as a result of the enzyme-antibody-antigen reaction is proportional to the concentration of the antigen and can be measured spectrophotometrically or with the naked eye. Many variations of the method have been developed. St. Louis Encephalitis Virus, por sus siglas 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 inglés) o 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). La terapia de rehidratación oral es el pilar del tratamiento. Una vacuna viva atenuada está disponible.
• Campylobacter jejuni Campylobacter jejuni A species of bacteria that resemble small tightly coiled spirals. Its organisms are known to cause abortion in sheep and fever and enteritis in man and may be associated with enteric diseases of calves, lambs, and other animals. Campylobacter: bacilos Gram-negativos curvos. Los LOS Neisseria síntomas comunes de infección son fiebre, cefalea, dolor Dolor Inflammation abdominal intenso, mialgias y diarrea. La diarrea a veces es sanguinolenta. 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 raras ocasiones, los LOS Neisseria pacientes pueden presentar artritis, 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 o 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. El diagnóstico se puede hacer mediante un coprocultivo. El tratamiento incluye terapia de rehidratación y antibióticos (e.g., macrólidos o fluoroquinolonas).
• Shigellosis Shigellosis Shigella: una infección bacteriana aguda del tracto gastrointestinal. La shigellosis Shigellosis Shigella es causada por la especie Gram-negativa Shigella Shigella Shigella is a genus of gram-negative, non-lactose-fermenting facultative intracellular bacilli. Infection spreads most commonly via person-to-person contact or through contaminated food and water. Humans are the only known reservoir. Shigella. Los LOS Neisseria pacientes desarrollan síntomas de fiebre, tenesmo y diarrea sanguinolenta. La infección se diagnostica clínicamente y se confirma mediante un coprocultivo. El tratamiento puede incluir terapia de rehidratación y antibióticos ( 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 casos graves o para pacientes de alto riesgo).
• Salmonella Salmonella Salmonellae are gram-negative bacilli of the family Enterobacteriaceae. Salmonellae are flagellated, non-lactose-fermenting, and hydrogen sulfide-producing microbes. Salmonella enterica, the most common disease-causing species in humans, is further classified based on serotype as typhoidal (S. typhi and paratyphi) and nontyphoidal (S. enteritidis and typhimurium). Salmonella no tifoidea: una infección causada por los LOS Neisseria bacilos Gram-negativos, S. enteritidis S. enteritidis A serotype of Salmonella enterica which is an etiologic agent of gastroenteritis in man and other animals. Salmonella o S. typhimurium S. typhimurium A serotype of Salmonella enterica that is a frequent agent of Salmonella gastroenteritis in humans. It also causes paratyphoid fever. Salmonella. Pueden presentarse vómitos, cólicos abdominales, fiebre y diarrea inflamatoria. Los LOS Neisseria coprocultivos pueden proporcionar el diagnóstico. El tratamiento es de soporte y los LOS Neisseria antibióticos solo se usan para manifestaciones sistémicas o para controlar la diarrea severa.
• Giardiasis Giardiasis An infection of the small intestine caused by the flagellated protozoan giardia. It is spread via contaminated food and water and by direct person-to-person contact. Giardia/Giardiasis: una infección causada por Giardia Giardia A genus of flagellate intestinal eukaryotes parasitic in various vertebrates, including humans. Characteristics include the presence of four pairs of flagella arising from a complicated system of axonemes and cysts that are ellipsoidal to ovoidal in shape. Nitroimidazoles lamblia, un protozoo flagelado que puede infectar el tracto intestinal. El síntoma característico de la giardiasis Giardiasis An infection of the small intestine caused by the flagellated protozoan giardia. It is spread via contaminated food and water and by direct person-to-person contact. Giardia/Giardiasis es la esteatorrea maloliente. Los LOS Neisseria pacientes que desarrollan infecciones crónicas pueden experimentar pérdida de peso, retraso 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 crecimiento y deficiencias vitamínicas como resultado de la malabsorción. El diagnóstico se realiza mediante la detección de organismos, antígenos o ADN de Giardia Giardia A genus of flagellate intestinal eukaryotes parasitic in various vertebrates, including humans. Characteristics include the presence of four pairs of flagella arising from a complicated system of axonemes and cysts that are ellipsoidal to ovoidal in shape. Nitroimidazoles 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 heces. El tratamiento incluye terapia de soporte y terapia antimicrobiana con metronidazol, tinidazol o nitazoxanida.