several petechiaes on a positive #Tourniquet-test. The test | Figure 1

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Several petechiaes on a positive #Tourniquet-test. The test is a marker of capillary fragility and it can be used as a triage tool, showing bleeding manifestations of dengue, in this case.

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Dengue hemorrhagic fever, a severe form of dengue, was first seen in Thailand and the Philippines in the 1950s. Today it is a leading cause of death among children in Asia and Latin America. It is characterized by fever, thrombocytopenia, hemorrhage, and increased vascular permeability. A tourniquet test can be a useful triage tool: A blood pressure (BP) cuff is inflated midway between the systolic and diastolic BP for 5 minutes, then deflated. The test is positive if 10 or more petechiae form in 1 square inch below the antecubital fossa after 2 minutes, as seen here.

Brazilian researchers develop a test that detects zika, dengue and chikungunya at the same time. The test was developed by the Bio-Manguinhos laboratory of the Oswaldo Cruz Foundation (Fiocruz) in conjunction with the Molecular Biology Institute of Paraná, under the coordination of the Ministry of Health. From the patient's blood it is possible to identify the RNA of the three viruses and allows Determine which of the arboviruses transmitted by the Aedes aegypti mosquito is present in the sample. The technique used in the test is real-time PCR, and a complete diagnosis of the three viruses can be made for partial diagnoses of one or two of them, separately, and such a test makes possible the diagnosis in the initial phase of infection. The patient's blood is added to a gauge particle, which consists of a virus with similar characteristics, produced and patented by Fiocruz, but without infectious potential. The result is obtained in five hours.

Positive tourniquet test on the antecubital part (petechiae), visible blood extraction site at the center. Patient suspected of dengue hemorrhagic fever, tested positive for dengue NS1 test, platelet at very low level.

Dengue???

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?