Dengue fever is the most important arboviral infection in the world, with an estimated 100 million cases per year and 2.5 billion people at risk. Encephalopathy is a rare complication of dengue virus infection and may occur as a consequence of intracranial hemorrhage, cerebral edema, hyponatremia, cerebral anoxia, fulminant hepatic failure with portosystemic encephalopathy, microcapillary hemorrhage or release of toxic products. We report a rare case of hemorrhagic encephalopathy in dengue shock syndrome caused by type 3 dengue virus.

Analyses of the 2009 H1N1 influenza pandemic and post-pandemic years showed high attack rates and severity among indigenous populations. This study presents the characteristics of the first documented influenza outbreak in indigenous peoples in Brazil, that occurred from 30th March to 14th April 2016 in a Guarani village in Southeast Region. Acute respiratory infections were prospectively investigated. The majority of the 73 cases were influenza-like illness (ILI) (63.0%) or severe acute respiratory infection (SARI) (20.5%). The ILI+SARI attack rate (35.9%) decreased with increasing age. There was a high influenza vaccination rate (86.3%), but no statistically significant difference in vaccination rates between severe and non-severe cases was seen (p = 0.334). Molecular analyses of 19.2% of the cases showed 100% positivity for influenza A(H1N1)pdm09 and/or hRSV. Influenza A(H1N1)pdm09 was included in the 6B.1 genetic group, a distinct cluster with 13 amino acid substitutions of A/California/07/2009-like. The hRSV were clustered in the BA-like genetic group. The early arrival of the influenza season overlapping usual hRSV season, the circulation of a drifted influenza virus not covered by vaccine and the high prevalence of risk factors for infection and severity in the village jointly can explain the high attack rate of ARI, even with a high rate of influenza vaccination. The results reinforce the importance of surveillance of respiratory viruses, timely vaccination and controlling risk factors for infection and severity of in the indigenous populations in order to preventing disease and related deaths, particularly in children.

An 80-year-old man with stage 4 chronic renal disease, chronically medicated with amiodarone, presented with a vesiculopustular eruption on his face and neck two days after undergoing chest computed angiotomography with iodinated contrast. A skin biopsy showed dense neutrophilic infiltrate with cryptococcus-like structures. Clinicopathological correlation allowed the diagnosis of iododerma, which was later confirmed by raised serum iodine levels. Iododerma is a rare dermatosis triggered by the exposure to iodinated contrast and/or iodine-containing drugs. Although rare, dermatologists must recognize this polymorphic entity, mainly prevalent in patients with renal insufficiency.

Mumps is an infectious disease caused by a paramyxovirus. It can involve several organs in the acute stage of the infection, including central nervous system. (Rubin et al., 2015) [ 1 ] Neurological complications in the post-infectious period are also described, one of which is acute disseminated encephalomyelitis (ADEM). (Jonhson et al., 2004) [ 2 ] We present the case of an healthy young man previously vaccinated, who contracted ADEM after mumps.