New disease can reach the five continents, infectious disease specialist warns

Publicação: 10 de September de 2022

It is not Covid-19, it is also not chickenpox and can be confused with Hand-Foot-Mouth syndrome, new virus causes red rash, with painful blisters, similar to monkeypox

According to the study, like the flu, the new disease is quite contagious. However, viral infection appears to be non-fatal

Health problems do not end and have even increased recently. After Covid-19, the childhood hepatitis of unknown origin that has already caused the death of some babies, the monkeypox the reappearance of polio in New York after more than a decade since the last reported case, now another pathology that has been called “tomato flu” has been added to the list. The discovery was revealed in an article published in The Lancet on 17 August titled Tomato flu outbreak in India. Currently the disease is considered an outbreak in India.

According to Dr. Kleber Luz, a professor at the Department of Infectious Diseases of the Federal University of Rio Grande do Norte (UFRN) Medical School, although it is restricted to Asia, because it is a respiratory transmission disease and quite contagious, it can spread. “There is always the risk of a disease spreading and, although it only affects children, it can spread and become epidemic in Asia, it can spread to the five continents and thus become pandemic, or be restricted to one region and Asia and become endemic,” he says. However, Dr. Luz recommends tranquility. According to him, the disease, despite having an important morbidity, bringing important suffering to children, is not associated with lethality. “As there have been no cases in Brazil so far, there is no special recommendation for either children or parents,” he adds.

There is still no specific medication to treat it and the therapeutic recommendation is the use of symptomatic drugs, such as paracetamol or dipyrone to control fever or pain. “Because it is a disease that produces skin manifestations, blisters, the ideal is that these are kept clean. Whenever possible, at least once a day, wash them with water and liquid soap to keep them clean and, if obviously, some inflammation arises in the skin, which we call cellulite, which causes a lot of pain, the child should use antibiotics, since there may have been invasion by streptococci or staphylococcus, as occurs in monkeypox”, explains the infectologist. In addition, the sick child should be isolated until there is a complete resolution of clinical manifestations. The main symptoms observed in this audience include fever, muscle pain, headache, joint pain (astralgia), fatigue, nausea, vomiting, diarrhea, fever, dehydration, rash. “At first, everything refers to a viral infectious disease. What should be attentive is for dengue, since it is the most serious disease of all,” he warns.

Differential diagnosis

Regarding the differential diagnosis of tomato flu, Dr. Luz points out that this will be established among febrile diseases, for example, dengue, chikungunya, zika, or other febrile infectious diseases. “As the disease has respiratory symptoms, the differential diagnosis should always be made with the common cold and, mainly, with Influenza (flu), and also with SARS-CoV-2. If the child has respiratory symptoms, RT-PCR should be collected in a nasal swab or antigen research in the mouth or nose to investigate if it is Covid-19,” he details. Monkeypox is also part of the differential diagnosis, although it is classically a disease of adults and not of young children, it is important to collect material (swab) to perform the RT-PCR test. Also according to the infectologist, an important and differential diagnosis is Hand-Foot-Mouth Syndrome, a contagious disease that has spread worldwide in the last year, caused by the Coxsackie virus, belonging to the family of enteroviruses that normally inhabit the digestive system. This disease is usually benign. “However, in recent years there have been more aggressive Coxsackie viruses that can produce, for example, inflammation in the heart muscle (myocarditis), acute pericarditis that can translate into greater severity and this patient may need, for example, hospitalization,” he ponders.

For Dr. Luz, possibly tomato flu is a disease in itself and should not be a consequence of chikungunya or Covid-19. “I believe it is an enterovirus or a virus similar to Coxsackie, and that this virus has its own behavior and will itself produce muscle and joint pain, respiratory symptoms and skin lesions. Although publications on the subject are still few and references are many newspaper news, I really believe it is a disease in itself,” he emphasizes. For now, doubts about the source of the problem remain unanswered and we will have to wait a while for some definitions.

Asked if it could be a new variant of the Coxsackie virus, Dr. Luz recognizes that it can be a Coxsackie, which can produce lesions of the exclusive oral cavity, or belong to the group of enteroviruses, transmissible viruses that usually produce diseases in the pediatric group that are characterized by fever and cutaneous and mucosal manifestation. “Enteroviruses produce rash (rash), vesicles, such as Hand-Foot-Mouth Syndrome. The Coxsackie. “Generally these viruses have a tropism for the production of skin or mucosal-cutaneous lesions or only mucous membranes. At the beginning of the disease, in the first two to three days, there may be the appearance of general symptoms such as fever, malaise, muscle and joint pain, symptoms common to these diseases produced by enteroviruses, especially Coxsackie,” he explains.

Like the flu, the new infection is quite contagious and transmission is similar to respiratory diseases, that is, through direct contact between a sick child and a healthy one, and also through droplets. To avoid contagion, it is important to keep the sick individual absolutely isolated, not to touch the lesions, to keep at least one meter away, to keep hands clean, not to touch objects and surfaces, and to bring the hand directly to the mouth. “As the disease is extremely transmissible, the chance of many cases occurring is great,” warns Dr. Luz.

Origin of the name

The term “tomato flu” was given to the infection due to the red blisters that form in the body of the affected individuals. They resemble those observed with monkeypox virus in young individuals. The disease has been described as an infection caused by an unidentified virus. The first case occurred in the Kollam district of Kerala, India, on May 6, 2022. On July 26, 2022, 82 children under the age of five were registered with the infection in the Asian country. In the state of Odisha, 26 children between one and nine years old were diagnosed with the disease, according to the Regional Medical Research Center in Bhubaneswar. So far the infection is in an endemic state.