Oliveira Henrique Souza Barros de, Araujo Patricia Padial de, Sousa Jamile Rafaela Poltronieri de, Donis Ana Carolina Gariba, Moreira Deise, Makssoudian Andrea
Centro Universitário São Camilo, São Paulo, SP, Brazil.
Hospital Geral de Carapicuíba, Carapicuíba, SP, Brazil.
Einstein (Sao Paulo). 2020 Feb 17;18:eRC5041. doi: 10.31744/einstein_journal/2020RC5041. eCollection 2020.
The yellow fever is a systemic disease that was under control due to the effective campaigns against the vector and promotion of vaccines programs. However, since 1999, outbreaks appeared because of inefficient control of the vector, and led to the need of amplifying the immunization in large scale against the yellow fever virus, and consequently, raising the risk of adverse reactions to the vaccine. We report a case of previously healthy infant, who was referred to our care service, after 3 days with fever, chills, nausea and vomits, he received support therapy and was discharged from the hospital. After 24 hours of supportive measures, he was discharge. The patient returned to our service with general condition decline, strabismus, inability to control of cervical musculature and reduced force of the legs. The patient vaccine had received all vaccines from the calendar, and he was vaccinated for yellow fever 20 days before symptoms. During the hospitalization, liquor was collected, and ceftriaxone and aciclovir were administered. After negative cultures from the liquor, the antibiotics were suspended. The computed tomography of patient's brain showed no alterations. Research for antibodies against yellow fever was requested, being positive for IgM in the liquor, and confirming the neurotropic disease associated with the yellow fever vaccine. On the fifth day of hospitalization, the patient showed improvement on the strabismus, cervical tonus, and musculature force. On the tenth day of hospitalization, patient showed complete improvement, and his laboratory exams no alterations. Subsequently, patient was discharged. The vaccine against yellow fever is safe, efficient and highly recommended, however it is not completely free from serious adverse reactions, including death.
黄热病是一种全身性疾病，由于针对病媒的有效防治运动和疫苗接种计划的推广，该疾病曾得到控制。然而，自1999年以来，由于对病媒控制不力，疫情爆发，导致需要大规模加强针对黄热病毒的免疫接种，从而增加了疫苗不良反应的风险。我们报告一例先前健康的婴儿病例，该婴儿在出现发热、寒战、恶心和呕吐3天后被转诊至我们的护理服务机构，接受了支持性治疗后出院。在采取支持性措施24小时后，他出院了。该患者因全身状况恶化、斜视、无法控制颈部肌肉组织以及腿部力量减弱再次回到我们的服务机构。该患者已按照免疫程序接种了所有疫苗，在出现症状前20天接种了黄热病疫苗。住院期间，采集了脑脊液，给予了头孢曲松和阿昔洛韦。脑脊液培养结果为阴性后，停用了抗生素。患者脑部的计算机断层扫描未显示异常。要求检测针对黄热病的抗体，脑脊液中IgM呈阳性，证实了与黄热病疫苗相关的嗜神经性疾病。住院第五天，患者的斜视、颈部张力和肌肉力量有所改善。住院第十天，患者完全康复，实验室检查无异常。随后，患者出院。黄热病疫苗安全、有效且强烈推荐使用，然而它并非完全没有严重的不良反应，包括死亡。
