Selected mosquito borne illnesses - Dengue

The Emergence of Travel-related Infections in Critical Care Units

Several tropical or geographically confined infectious diseases may lead to organ failure requiring management in an intensive care unit (ICU), both in endemic low- and middle-income countries where ICU facilities are increasingly being developed and in (nonendemic) high-income countries through an increase in international travel and migration. The ICU physician must know which of these diseases may be encountered and how to recognize, differentiate, and treat them. The four historically most prevalent "tropical" diseases (malaria, enteric fever, dengue, and rickettsiosis) can present with single or multiple organ failure in a very similar manner, which makes differentiation based solely on clinical signs very difficult. Specific but frequently subtle symptoms should be considered and related to the travel history of the patient, the geographic distribution of these diseases, and the incubation period. In the future, ICU physicians may also be more frequently confronted with rare but frequently lethal diseases, such as Ebola and other viral hemorrhagic fevers, leptospirosis, and yellow fever. No one could have foreseen the worldwide 2019-up to now coronavirus disease 2019 (COVID-19) crisis caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was initially spread by travel too. In addition, the actual pandemic due to SARS-CoV-2 reminds us of the actual and potential threat of (re)-emerging pathogens. If left untreated or when treated with a delay, many travel-related diseases remain an important cause of morbidity and even mortality, even when high-quality critical care is provided. Awareness and a high index of suspicion of these diseases is a key skill for the ICU physicians of today and tomorrow to develop.

Modeling spatial pattern of dengue in North Central Mexico using survey data and logistic regression

Dengue is a major public health concern mainly in tropical and subtropical environments worldwide. Despite several attempts to prevent this disease occurring in tropical regions of Mexico, it has not yet been controlled. This work focused on spatial modeling of confirmed dengue fever cases that occurred during the period 2010-2014 in the Huasteca Potosina region of Mexico. Multivariable Logistic Regression Modeling (MLRM) was used to determine the relationship between explanatory variables and the presence/absence of dengue. Model performance was evaluated using the area under curve (AUC) of the relative operating characteristic (ROC); AUC > 0.95. A high spatial resolution map was created to reveal the most probable patterns of dengue risk. Our results can be used for targeted control and prevention programs at local and regional levels. This methodology can be applied to other major diseases that are spatially distributed in accordance with environmental factors.

Hormonal regulation of microRNA expression dynamics in the gut of the yellow fever mosquito Aedes aegypti

The yellow fever mosquito Aedes aegypti is an obligatory blood feeder and a major arboviral disease vector, evoking severe public health concerns worldwide. In adult female mosquitoes, the gut is critical for blood digestion and pathogen entry. We aimed for a systematic exploration of microRNA expression dynamics in the gut during the gonadotrophic cycle. Small RNA libraries were constructed from female mosquito gut tissues at five time points. Unsupervised hierarchical clustering revealed three expression clusters (early, mid and late) peaking at sequential time points - 24, 48 and 72 h posteclosion. Differentially expressed miRNAs were identified at 24 h post-blood meal (PBM). Depletions of Methoprene-tolerant [Met; the juvenile hormone (JH) receptor] and Ecdysone receptor [EcR; the receptor to 20-hydroxyecdysone (20E)] were performed using dsRNA to these genes to investigate impacts on microRNA expressions. Our results suggest that Met-mediated signalling downregulates miRNA expression from the early cluster and upregulates that from the late cluster. EcR signalling either up- or downregulated miRNA levels at 24 h PBM, indicating a differential effect of this receptor in miRNA gene expression. Furthermore, miR-281, which is the most abundant miRNA in the gut tissue, is induced and repressed by Met- and EcR-mediated signalling, respectively. Systematic depletion using synthetic antagomir and phenotype examinations indicate that miR-281 is obligatory for the normal progression of blood digestion, ovarian development and reproduction. Collectively, this study unveils expression dynamics of microRNAs in the female gut tissue during the gonadotrophic cycle and demonstrates that they are affected by JH and 20E signalling.

Risk factors for death among patients with Chikungunya virus infection during the outbreak in northeast Brazil, 2016-2017

BACKGROUND

Chikungunya virus (CHIKV) infection is a current public health problem. The aim of this study was to investigate risk factors for death among patients with CHIKV infection during a large epidemic in northeast Brazil.

METHODS

This is a cross-sectional study with all registered cases of CHIKV in Ceara, Brazil, during 2016-2017. Data from notification reports were collected, and we have compared non-survivors and survivors.

RESULTS

A total of 182 731 cases were reported, with a mean age of 38±19 years, and the majority was female (62%). There were 383 deaths. Non-survivors were elderly, with a predominance of males, and with a lower educational level. Conditions that were significantly more frequent in the non-survivor group were systemic arterial hypertension, diabetes mellitus and chronic kidney disease (p<0.0001). Independent risk factors for death were advanced age (OR 7.35, p<0.0001), male gender (OR 2.05, p<0.0001), leukopenia (OR 3.18, p<0.0001) and vomiting (OR 2.19, p<0.0001), and comorbidities like hypertension (OR 3.74, p<0.0001), diabetes (OR 3.29, p<0.0001) and chronic kidney disease (OR 3.14, p<0.0001).

CONCLUSION

Advanced age and low educational level were associated with higher risk of mortality in CHIKV. Leukopenia and vomiting were signs of severity, as well as the presence of comorbidities, especially hypertension, diabetes and kidney disease.