1
|
dos Santos BF, Gandolfi FA, Milhim BHGA, Dourado FS, Silva GCD, Zini N, Gratão VHR, Mariani MP, Abbas TN, Garcia PHC, Rocha RS, Vasilakis N, Nogueira ML, Estofolete CF. Diabetes as risk factor to severity of dengue in naïve patients. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.27.24306485. [PMID: 38746281 PMCID: PMC11092716 DOI: 10.1101/2024.04.27.24306485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Background Dengue cases can progress to severe ant life-threating forms particularly in subsequent heterologous infections. However, recent studies had explored additional risk factors, including underlying health conditions, even in individuals without prior exposure to dengue, notably, in patients with endothelial dysfunction and chronic inflammation. This study examines the link between diabetes and the development of severe dengue disease in dengue-naive patients during the 2019 dengue outbreak in São Jose do Rio Preto, Brazil. Methodology We enrolled 529 laboratory-confirmed dengue cases, identified through DENV RT-PCR or NS1 antigen assays in a hospital cohort of acute febrile illness. Subsequently, we investigated the presence of anti-dengue and anti-Zika IgG antibodies. Samples testing positive for Zika were excluded from the analyses. Two groups were analyzed: naïve (DV-), and dengue history (DV+). Results Initially, presence of diabetes and kidney disease, as well as being dengue-naive, were associated with a higher frequency of severe and potentially severe clinical outcomes. Multivariate analysis identified diabetes as a risk factor, while the presence of anti-dengue antibodies was considered protective. Analysis of dengue naïve samples, highlighted diabetes as an independent risk factor to severe forms of dengue disease. In DV+ patients, no condition was highlighted as a risk factor by univariate analysis or multivariate analysis. Conclusions We investigated and confirmed diabetes as a risk factor for severe dengue disease in individuals without prior dengue or Zika exposure. Our conclusions raise significant concerns given diabetes' ever increasing global prevalence and its potential impact on patients with or previous dengue exposure.
Collapse
Affiliation(s)
- Bárbara F. dos Santos
- Laboratório de Pesquisas em Virologia (LPV), Faculdade de Medicina de São José do Rio Preto (FAMERP); São José do Rio Preto, São Paulo, Brazil
| | - Flora A. Gandolfi
- Laboratório de Pesquisas em Virologia (LPV), Faculdade de Medicina de São José do Rio Preto (FAMERP); São José do Rio Preto, São Paulo, Brazil
| | - Bruno H. G. A. Milhim
- Laboratório de Pesquisas em Virologia (LPV), Faculdade de Medicina de São José do Rio Preto (FAMERP); São José do Rio Preto, São Paulo, Brazil
| | - Fernanda S. Dourado
- Laboratório de Pesquisas em Virologia (LPV), Faculdade de Medicina de São José do Rio Preto (FAMERP); São José do Rio Preto, São Paulo, Brazil
| | - Gislaine C. D. Silva
- Laboratório de Pesquisas em Virologia (LPV), Faculdade de Medicina de São José do Rio Preto (FAMERP); São José do Rio Preto, São Paulo, Brazil
| | - Nathalia Zini
- Laboratório de Pesquisas em Virologia (LPV), Faculdade de Medicina de São José do Rio Preto (FAMERP); São José do Rio Preto, São Paulo, Brazil
| | - Victor Hugo Rezende Gratão
- Laboratório de Pesquisas em Virologia (LPV), Faculdade de Medicina de São José do Rio Preto (FAMERP); São José do Rio Preto, São Paulo, Brazil
| | - Matheus Pascoal Mariani
- Laboratório de Pesquisas em Virologia (LPV), Faculdade de Medicina de São José do Rio Preto (FAMERP); São José do Rio Preto, São Paulo, Brazil
| | - Tamires Nasie Abbas
- Laboratório de Pesquisas em Virologia (LPV), Faculdade de Medicina de São José do Rio Preto (FAMERP); São José do Rio Preto, São Paulo, Brazil
| | - Pedro H. C. Garcia
- Laboratório de Pesquisas em Virologia (LPV), Faculdade de Medicina de São José do Rio Preto (FAMERP); São José do Rio Preto, São Paulo, Brazil
| | - Rodrigo S. Rocha
- Laboratório de Pesquisas em Virologia (LPV), Faculdade de Medicina de São José do Rio Preto (FAMERP); São José do Rio Preto, São Paulo, Brazil
| | - Nikos Vasilakis
- Department of Pathology, University of Texas Medical Branch; Galveston, Texas, USA
- Center for Vector-Borne and Zoonotic Diseases, University of Texas Medical Branch; Galveston, Texas, USA
- Institute for Human Infection and Immunity, University of Texas Medical Branch; Galveston, Texas, USA
| | - Maurício L. Nogueira
- Laboratório de Pesquisas em Virologia (LPV), Faculdade de Medicina de São José do Rio Preto (FAMERP); São José do Rio Preto, São Paulo, Brazil
- Department of Pathology, University of Texas Medical Branch; Galveston, Texas, USA
- Hospital de Base (HB), São José do Rio Preto, São Paulo, Brazil
| | - Cássia F. Estofolete
- Laboratório de Pesquisas em Virologia (LPV), Faculdade de Medicina de São José do Rio Preto (FAMERP); São José do Rio Preto, São Paulo, Brazil
- Hospital de Base (HB), São José do Rio Preto, São Paulo, Brazil
| |
Collapse
|
2
|
Clipes MVS, Vicente CR, Cardoso da Silva TC, Resende LC, Cerutti Junior C. Analysis of spatial and demographic factors associated with chikungunya in Espírito Santo state, Brazil. Trans R Soc Trop Med Hyg 2024:trae019. [PMID: 38650504 DOI: 10.1093/trstmh/trae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/08/2024] [Accepted: 03/20/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Chikungunya (CHIK) emerged in Brazil in 2014 and since then several epidemics have been observed. This study aims to describe the spatial, social and demographic characteristics of individuals affected by CHIK in Espírito Santo state. METHODS A cross-sectional study was performed using data from individuals with a confirmed diagnosis of CHIK in Espírito Santo state, Brazil, from 2018 to 2020. Monthly incidence was calculated and annual spatial distribution maps were constructed. Statistical analysis using the χ2 test identified associations between disease occurrence and sociodemographic variables. RESULTS In the period and area analysed, a CHIK epidemic occurred in 2020, with an incidence of 219.8 cases per 100 000 inhabitants. The southern and central regions of Espirito Santo state harboured a risk five times greater than the others in the epidemic region. Females (odds ratio [OR] 1.65 [95% confidence interval {CI} 1.58 to 1.72]), black people (OR 1.22 [95% CI 1.13 to 1.33]), individuals with ≤11 y of education (OR 1.48 [95% CI 1.37 to 1.61]) and the elderly (OR 7.49 [95% CI 6.53 to 8.59]) had a greater risk for the disease. CONCLUSIONS CHIK stands as an emerging public health problem in Brazil since its introduction in 2014. Espírito Santo suffered a substantial epidemic in 2020, possibly due to outbreaks in neighbouring states. The population at risk should be prioritized in healthcare, considering the morbidity potential of the disease.
Collapse
Affiliation(s)
- Marcus Vinicius Salvador Clipes
- Post-Graduate Program of Infectious Diseases, Federal University of Espirito Santo, Vitória, Marechal Campos Avenue, 1468, 29047-105, Espírito Santo, Brazil
| | - Creuza Rachel Vicente
- Post-Graduate Program of Infectious Diseases, Federal University of Espirito Santo, Vitória, Marechal Campos Avenue, 1468, 29047-105, Espírito Santo, Brazil
| | - Theresa Cristina Cardoso da Silva
- Special Nucleus of Epidemiologic Surveillance from the State Department of Health, Vitória, Marechal Mascarenha de Moraes Avenue, 29050-755, Espírito Santo, Brazil
| | - Lilyan Correia Resende
- Post-Graduate Program of Infectious Diseases, Federal University of Espirito Santo, Vitória, Marechal Campos Avenue, 1468, 29047-105, Espírito Santo, Brazil
| | - Crispim Cerutti Junior
- Post-Graduate Program of Infectious Diseases, Federal University of Espirito Santo, Vitória, Marechal Campos Avenue, 1468, 29047-105, Espírito Santo, Brazil
| |
Collapse
|
3
|
Henrique Ferreira Sucupira P, Silveira Ferreira M, Santos Coutinho-da-Silva M, Alves Bicalho K, Carolina Campi-Azevedo A, Pedro Brito-de-Sousa J, Peruhype-Magalhães V, Rios M, Konduru K, Teixeira-Carvalho A, Grazziela Alves Coelho-Dos-Reis J, Ribeiro do Valle Antonelli L, Bortolo de Rezende V, Ludolf Ribeiro de Melo F, Couto Garcia C, Carla Silva-Andrade J, Artur da Costa-Rocha I, Alves da Rocha L, Aprigio Silva V, Damasceno Pinto S, Araújo de Melo S, Guimarães Costa A, de Souza Gomes M, Rodrigues Amaral L, Luiz Lima Bertarini P, Cristina da Silva Furtado E, Vieira Pinto da Silva E, Alves Ramos B, Barros Dos Santos É, Nazaré Oliveira Freitas M, Maria Caetano Faria A, Fernando da Costa Vasconcelos P, de Souza Bastos M, Carício Martins L, Assis Martins-Filho O, Sobreira Silva Araújo M. Serotype-associated immune response and network immunoclusters in children and adults during acute Dengue virus infection. Cytokine 2023; 169:156306. [PMID: 37542834 DOI: 10.1016/j.cyto.2023.156306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/24/2023] [Accepted: 07/18/2023] [Indexed: 08/07/2023]
Abstract
The present study was designed as an exploratory investigation to characterize the overall profile of chemokines, growth factors, and pro-inflammatory/regulatory cytokines during acute DENV infection according to DENV-1, DENV-2, DENV-4 serotypes and age: children: <1-10-year-old (yo); adolescents:11-20 yo; adults 21-40 yo; and older adults: 41-75 yo. The levels of soluble immunemediators were measured in serum by high-throughput microbeads array in 636 subjects including 317 DENV-infected and 319 age-matching non-infected control (NI). Overall, most soluble mediators were increased in DENV-infected patients as compared to NI group regardless of age and DENV serotype, with high magnitude order of increase for CCL2, CXCL10, IL-1β, IFN-γ, IL1-Ra (fold change >3x), except PDGF in which no fold change was observed. Moreover, despite the age ranges, DENV-1 and DENV-4 presented increased levels of VEGF, IL-6, and TNF-α in serum but decreased levels of PDGF, while DENV-2 exhibited increased levels of CXCL8, CCL4, and IL-12. Noteworthy was that DENV-2 showed increased levels of IL-12, IL-15, IL-17, IL-4, IL-9, and IL-13, and maintained an unaltered levels of PDGF at younger ages (<1-10 yo and 11-20 yo), whereas in older ages (21-40 yo and 41-75 yo), the results showed increased levels of CCL2, IL-6, and TNF-α, but lower levels of PDGF. In general, DENV infection at younger age groups exhibited more complex network immunoclusters as compared to older age groups. Multivariate analysis revealed a clustering of DENV cases according to age for a set of soluble mediators especially in subjects infected with DENV-2 serotype. Altogether, our findings demonstrate that the profile of circulating soluble mediators differs substantially in acute DENV according to age and DENV serotypes suggesting the participation of serotype-associated immune response, which may represent a potential target for development of therapeutics and could be used to assist medical directive for precise clinical management of severe cases.
Collapse
Affiliation(s)
| | | | | | - Kelly Alves Bicalho
- Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ-Minas), Belo Horizonte, MG, Brazil
| | | | | | | | - Maria Rios
- Office of Blood Research and Review (OBRR), Center for Biologics Evaluation and Research (CBER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Krishnamurthy Konduru
- Office of Blood Research and Review (OBRR), Center for Biologics Evaluation and Research (CBER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | | | | | | | | | - Fernanda Ludolf Ribeiro de Melo
- Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ-Minas), Belo Horizonte, MG, Brazil; Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Cristiana Couto Garcia
- Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ-Minas), Belo Horizonte, MG, Brazil; Laboratório de Vírus Respiratórios e Sarampo, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, RJ, Brazil
| | | | | | - Lucia Alves da Rocha
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil; Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
| | | | | | | | - Allyson Guimarães Costa
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil; Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil; Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
| | - Matheus de Souza Gomes
- Laboratório de Bioinformática e Análises Moleculares, Rede Multidisciplinar de Pesquisa, Ciência e Tecnologia, Universidade Federal de Uberlândia (UFU), Campus Patos de Minas, Minas Gerais, Brazil; Laboratório de Tecnologias Urbanas e Rurais, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia (UFU), Campus Patos de Minas, Minas Gerais, Brazil
| | - Laurence Rodrigues Amaral
- Laboratório de Bioinformática e Análises Moleculares, Rede Multidisciplinar de Pesquisa, Ciência e Tecnologia, Universidade Federal de Uberlândia (UFU), Campus Patos de Minas, Minas Gerais, Brazil; Laboratório de Tecnologias Urbanas e Rurais, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia (UFU), Campus Patos de Minas, Minas Gerais, Brazil
| | - Pedro Luiz Lima Bertarini
- Laboratório de Bioinformática e Análises Moleculares, Rede Multidisciplinar de Pesquisa, Ciência e Tecnologia, Universidade Federal de Uberlândia (UFU), Campus Patos de Minas, Minas Gerais, Brazil; Laboratório de Tecnologias Urbanas e Rurais, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia (UFU), Campus Patos de Minas, Minas Gerais, Brazil
| | | | | | - Bruna Alves Ramos
- Instituto Evandro Chagas, Rodovia BR-316 KM 7 S/N, Ananindeua, PA, Brazil
| | | | | | - Ana Maria Caetano Faria
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Pedro Fernando da Costa Vasconcelos
- Instituto Evandro Chagas, Rodovia BR-316 KM 7 S/N, Ananindeua, PA, Brazil; Departamento de Patologia, Centro de Ciências Biológicas e da Saúde, Universidade do Estado do Pará, Belém, PA, Brazil
| | - Michele de Souza Bastos
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil; Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil.
| | | | | | | |
Collapse
|
4
|
Kaagaard MD, Wegener A, Gomes LC, Holm AE, Lima KO, Matos LO, Vieira IVM, de Souza RM, Vestergaard LS, Marinho CRF, Dos Santos FB, Biering-Sørensen T, Silvestre OM, Brainin P. Potential role of transthoracic echocardiography for screening LV systolic dysfunction in patients with a history of dengue infection. A cross-sectional and cohort study and review of the literature. PLoS One 2022; 17:e0276725. [PMCID: PMC9674131 DOI: 10.1371/journal.pone.0276725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background Dengue virus can affect the cardiovascular system and men may be at higher risk of severe complications than women. We hypothesized that clinical dengue virus (DENV) infection could induce myocardial alterations of the left ventricle (LV) and that these changes could be detected by transthoracic echocardiography. Methodology/Principal findings We examined individuals from Acre in the Amazon Basin of Brazil in 2020 as part of the Malaria Heart Study. By questionnaires we collected information on self-reported prior dengue infection. All individuals underwent transthoracic echocardiography, analysis of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). We included 521 persons (mean age 40±15 years, 39% men, 50% urban areas) of which 253 (49%) had a history of dengue infection. In multivariable models adjusted for clinical and sociodemographic data, a history of self-reported dengue was significantly associated with lower LVEF (β = -2.37, P < 0.01) and lower GLS (β = 1.08, P < 0.01) in men, whereas no significant associations were found in women (P > 0.05). In line with these findings, men with a history of dengue had higher rates of LV systolic dysfunction (LVEF < 50% = 20%; GLS < 16% = 17%) than those without a history of dengue (LVEF < 50% = 7%; GLS < 16% = 8%; P < 0.01 and 0.06, respectively). Conclusions/Significance The findings of this study suggest that a clinical infection by dengue virus could induce myocardial alterations, mainly in men and in the LV, which could be detected by conventional transthoracic echocardiography. Hence, these results highlight a potential role of echocardiography for screening LV dysfunction in participants with a history of dengue infection. Further larger studies are warranted to validate the findings of this study.
Collapse
Affiliation(s)
- Molly D. Kaagaard
- Multidisciplinary Center, Federal University of Acre, Cruzeiro do Sul, Acre, Brazil
- Department of Cardiology, Copenhagen University Hospital–Herlev and Gentofte, Herlev, Denmark
| | - Alma Wegener
- Multidisciplinary Center, Federal University of Acre, Cruzeiro do Sul, Acre, Brazil
- Department of Cardiology, Copenhagen University Hospital–Herlev and Gentofte, Herlev, Denmark
| | - Laura C. Gomes
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Anna E. Holm
- Multidisciplinary Center, Federal University of Acre, Cruzeiro do Sul, Acre, Brazil
- Department of Cardiology, Copenhagen University Hospital–Herlev and Gentofte, Herlev, Denmark
| | - Karine O. Lima
- Multidisciplinary Center, Federal University of Acre, Cruzeiro do Sul, Acre, Brazil
| | - Luan O. Matos
- Multidisciplinary Center, Federal University of Acre, Cruzeiro do Sul, Acre, Brazil
| | | | | | - Lasse S. Vestergaard
- National Malaria Reference Laboratory, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | | | | | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital–Herlev and Gentofte, Herlev, Denmark
- Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Odilson M. Silvestre
- Health and Sport Science Center, Federal University of Acre, Rio Branco, Acre, Brazil
| | - Philip Brainin
- Multidisciplinary Center, Federal University of Acre, Cruzeiro do Sul, Acre, Brazil
- Department of Cardiology, Copenhagen University Hospital–Herlev and Gentofte, Herlev, Denmark
- * E-mail:
| |
Collapse
|
5
|
Cell strain-derived induced pluripotent stem cell as a genetically controlled approach to investigate age-related host response to flaviviral infection. J Virol 2021; 96:e0173721. [PMID: 34851147 PMCID: PMC8826815 DOI: 10.1128/jvi.01737-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The expansion of the geographical footprint of dengue viruses (DENVs) and their mosquito vectors have affected more than half of the global population, including older adults who appear to show elevated risk of severe dengue. Despite this epidemiological trend, how ageing contributes to increase dengue pathogenesis is poorly understood. A limitation has been the lack of useful in vitro experimental approaches; cell lines commonly used for infection studies are immortal and hence do not age. Cell strains, such as WI-38 and MRC-5 with diploid genomes, do age with in vitro passaging but these cell strains were isolated decades ago and are now mostly highly passaged. Herein, we show that reprogramming of cell strains with finite lifespan into induced pluripotent stem cells (iPSCs), followed by conversion back into terminally differentiated cells, can be an approach to derive genetically identical cells at different stages of ageing. The iPSC-derived differentiated cells were susceptible to wild-type DENV infection and produced greater levels of type-I interferon expression with increase passaging, despite similar levels of infection. In contrast, infection with the attenuated DENV-2 PDK53 and YF17D-204 strains showed reduced and increased levels of infection with increasing passages; the latter could be clinically pertinent as YF17D-204 vaccination in older adults is associated with increased risk of severe adverse outcome. The differences in infection susceptibility and host response collectively suggest the potential of iPSC-derived cell strains as a genetically controlled approach to understand how ageing impacts viral pathogenesis. Importance Ageing has been a risk factor for poor clinical outcome in several infectious diseases, including dengue. However, age-dependent responses to dengue and other flaviviral infection or vaccination have remained incompletely understood due partly to lack of suitable laboratory tools. We thus developed an in vitro approach to examine age-related changes in host response to flaviviral infection. Notably, this approach uses cell strains with diploid rather than aneuploidic genomes, which are unstable. Conversion of these cells into iPSCs ensure sustainability of this resource and reprogramming back into terminally differentiated cells would, even with limited number of passages, produce cells at different stages of ageing for infection studies. Our findings suggest that this in vitro system has the potential to serve as a genetically-controlled approach to define the age-related response to flavivirus infection.
Collapse
|
6
|
Ng WY, Ngim CF, Chow KY, Goh SXM, Zaid M, Dhanoa A. Clinical manifestations, laboratory profile and outcomes of dengue virus infection in hospitalised older patients. Trans R Soc Trop Med Hyg 2021; 116:545-554. [PMID: 34750632 DOI: 10.1093/trstmh/trab168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/27/2021] [Accepted: 10/24/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Due to an ageing population, dengue among older patients is encountered more frequently in many countries. Our study aimed to explore the clinico-laboratory parameters and outcomes among dengue-infected older patients in comparison with younger patients. METHODS This retrospective chart review involved dengue patients with dengue non-structural protein 1 (NS1) antigen positivity admitted to a tertiary hospital in Malaysia from January to July 2015. A comparison was made between older people (aged ≥60 y) and others. RESULTS Among 406 dengue patients, 43 (10.6%) were older people. Older dengue patients were less likely to present with persistent vomiting (adjusted OR [AOR] 0.247, 95% CI 0.093 to 0.656, p=0.005), while restlessness and confusion were more common at presentation (AOR 3.356, 95% CI 1.024 to 11.003, p=0.046). Older patients had significantly lower albumin upon admission (38 vs 40 g/L, p=0.036) and during hospital stay (35 vs 37 g/L, p=0.015). Compared with younger patients, older patients were more likely to have experienced nadir platelet counts of <50×109/L (AOR 2.897, 95% CI to 1.176 to 7.137, p=0.021). They were also more likely to require an extended hospital stay (AOR 3.547, 95% CI 1.575 to 7.986, p=0.002). CONCLUSIONS Diagnosis of dengue in older people may be challenging because of atypical presentations. Increased vigilance is necessary as there is an increased tendency to develop severe thrombocytopenia, hypoalbuminemia and prolonged hospitalisation in older people.
Collapse
Affiliation(s)
- Wei Yao Ng
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 80100, Johor Bahru, Johor, Malaysia.,Penang General Hospital, 10990, George Town, Penang, Malaysia
| | - Chin Fang Ngim
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 80100, Johor Bahru, Johor, Malaysia
| | - Kuan Yee Chow
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 80100, Johor Bahru, Johor, Malaysia
| | - Sarah Xiu Ming Goh
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 80100, Johor Bahru, Johor, Malaysia
| | - Masliza Zaid
- Department of Medicine, Hospital Sultanah Aminah, 80000, Johor Bahru, Johor, Malaysia
| | - Amreeta Dhanoa
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| |
Collapse
|
7
|
Nunes JGC, Nunes BTD, Shan C, Moraes AF, Silva TR, de Mendonça MHR, das Chagas LL, Silva FAE, Azevedo RSS, da Silva EVP, Martins LC, Chiang JO, Casseb LMN, Henriques DF, Vasconcelos PFC, Burbano RMR, Shi PY, Medeiros DBA. Reporter Virus Neutralization Test Evaluation for Dengue and Zika Virus Diagnosis in Flavivirus Endemic Area. Pathogens 2021; 10:840. [PMID: 34357990 PMCID: PMC8308650 DOI: 10.3390/pathogens10070840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/15/2021] [Accepted: 06/30/2021] [Indexed: 11/25/2022] Open
Abstract
Reporter virus neutralization test (RVNT) has been used as an alternative to the more laborious and time-demanding conventional PRNT assay for both DENV and ZIKV. However, few studies have investigated how these techniques would perform in epidemic areas with the circulation of multiple flavivirus. Here, we evaluate the performance of ZIKV and DENV Rluc RVNT and ZIKV mCh RVNT assays in comparison to the conventional PRNT assay against patient sera collected before and during ZIKV outbreak in Brazil. These samples were categorized into groups based on (1) acute and convalescent samples according to the time of disease, and (2) laboratorial diagnostic results (DENV and ZIKV RT-PCR and IgM-capture ELISA). Our results showed that DENV Rluc assay presented 100% and 78.3% sensitivity and specificity, respectively, with 93.3% accuracy, a similar performance to the traditional PRNT. ZIKV RVNT90, on the other hand, showed much better ZIKV antibody detection performance (around nine-fold higher) when compared to PRNT, with 88% clinical sensitivity. Specificity values were on average 76.8%. Even with these results, however, ZIKV RVNT90 alone was not able to reach a final diagnostic conclusion for secondary infection in human samples due to flavivirus cross reaction. As such, in regions where the flavivirus differential diagnosis represents a challenge, we suggest the establishment of a RVNT panel including other flaviviruses circulating in the region, associated with the other serological techniques such as IgM ELISA and the investigation of seroconversion, in order to help define an accurate diagnostic conclusion using serology.
Collapse
Affiliation(s)
- Jannyce G. C. Nunes
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch, Galveston, TX 77550, USA; (J.G.C.N.); (B.T.D.N.); (C.S.); (P.-Y.S.)
- Post Graduation Program in Parasitary Biology in the Amazon, Belém 66050-540, PA, Brazil
| | - Bruno T. D. Nunes
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch, Galveston, TX 77550, USA; (J.G.C.N.); (B.T.D.N.); (C.S.); (P.-Y.S.)
- Department of Arbovirology & Hemorrhagic Fever, Evandro Chagas Institute, Ananindeua 67015-120, PA, Brazil; (A.F.M.); (T.R.S.); (M.H.R.d.M.); (L.L.d.C.); (F.A.e.S.); (R.S.S.A.); (E.V.P.d.S.); (L.C.M.); (J.O.C.); (L.M.N.C.); (D.F.H.); (P.F.C.V.)
| | - Chao Shan
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch, Galveston, TX 77550, USA; (J.G.C.N.); (B.T.D.N.); (C.S.); (P.-Y.S.)
| | - Adriana F. Moraes
- Department of Arbovirology & Hemorrhagic Fever, Evandro Chagas Institute, Ananindeua 67015-120, PA, Brazil; (A.F.M.); (T.R.S.); (M.H.R.d.M.); (L.L.d.C.); (F.A.e.S.); (R.S.S.A.); (E.V.P.d.S.); (L.C.M.); (J.O.C.); (L.M.N.C.); (D.F.H.); (P.F.C.V.)
| | - Tais R. Silva
- Department of Arbovirology & Hemorrhagic Fever, Evandro Chagas Institute, Ananindeua 67015-120, PA, Brazil; (A.F.M.); (T.R.S.); (M.H.R.d.M.); (L.L.d.C.); (F.A.e.S.); (R.S.S.A.); (E.V.P.d.S.); (L.C.M.); (J.O.C.); (L.M.N.C.); (D.F.H.); (P.F.C.V.)
| | - Maria H. R. de Mendonça
- Department of Arbovirology & Hemorrhagic Fever, Evandro Chagas Institute, Ananindeua 67015-120, PA, Brazil; (A.F.M.); (T.R.S.); (M.H.R.d.M.); (L.L.d.C.); (F.A.e.S.); (R.S.S.A.); (E.V.P.d.S.); (L.C.M.); (J.O.C.); (L.M.N.C.); (D.F.H.); (P.F.C.V.)
| | - Liliane L. das Chagas
- Department of Arbovirology & Hemorrhagic Fever, Evandro Chagas Institute, Ananindeua 67015-120, PA, Brazil; (A.F.M.); (T.R.S.); (M.H.R.d.M.); (L.L.d.C.); (F.A.e.S.); (R.S.S.A.); (E.V.P.d.S.); (L.C.M.); (J.O.C.); (L.M.N.C.); (D.F.H.); (P.F.C.V.)
| | - Franco A. e Silva
- Department of Arbovirology & Hemorrhagic Fever, Evandro Chagas Institute, Ananindeua 67015-120, PA, Brazil; (A.F.M.); (T.R.S.); (M.H.R.d.M.); (L.L.d.C.); (F.A.e.S.); (R.S.S.A.); (E.V.P.d.S.); (L.C.M.); (J.O.C.); (L.M.N.C.); (D.F.H.); (P.F.C.V.)
| | - Raimunda S. S. Azevedo
- Department of Arbovirology & Hemorrhagic Fever, Evandro Chagas Institute, Ananindeua 67015-120, PA, Brazil; (A.F.M.); (T.R.S.); (M.H.R.d.M.); (L.L.d.C.); (F.A.e.S.); (R.S.S.A.); (E.V.P.d.S.); (L.C.M.); (J.O.C.); (L.M.N.C.); (D.F.H.); (P.F.C.V.)
| | - Eliana V. P. da Silva
- Department of Arbovirology & Hemorrhagic Fever, Evandro Chagas Institute, Ananindeua 67015-120, PA, Brazil; (A.F.M.); (T.R.S.); (M.H.R.d.M.); (L.L.d.C.); (F.A.e.S.); (R.S.S.A.); (E.V.P.d.S.); (L.C.M.); (J.O.C.); (L.M.N.C.); (D.F.H.); (P.F.C.V.)
| | - Livia C. Martins
- Department of Arbovirology & Hemorrhagic Fever, Evandro Chagas Institute, Ananindeua 67015-120, PA, Brazil; (A.F.M.); (T.R.S.); (M.H.R.d.M.); (L.L.d.C.); (F.A.e.S.); (R.S.S.A.); (E.V.P.d.S.); (L.C.M.); (J.O.C.); (L.M.N.C.); (D.F.H.); (P.F.C.V.)
| | - Jannifer O. Chiang
- Department of Arbovirology & Hemorrhagic Fever, Evandro Chagas Institute, Ananindeua 67015-120, PA, Brazil; (A.F.M.); (T.R.S.); (M.H.R.d.M.); (L.L.d.C.); (F.A.e.S.); (R.S.S.A.); (E.V.P.d.S.); (L.C.M.); (J.O.C.); (L.M.N.C.); (D.F.H.); (P.F.C.V.)
| | - Livia M. N. Casseb
- Department of Arbovirology & Hemorrhagic Fever, Evandro Chagas Institute, Ananindeua 67015-120, PA, Brazil; (A.F.M.); (T.R.S.); (M.H.R.d.M.); (L.L.d.C.); (F.A.e.S.); (R.S.S.A.); (E.V.P.d.S.); (L.C.M.); (J.O.C.); (L.M.N.C.); (D.F.H.); (P.F.C.V.)
| | - Daniele F. Henriques
- Department of Arbovirology & Hemorrhagic Fever, Evandro Chagas Institute, Ananindeua 67015-120, PA, Brazil; (A.F.M.); (T.R.S.); (M.H.R.d.M.); (L.L.d.C.); (F.A.e.S.); (R.S.S.A.); (E.V.P.d.S.); (L.C.M.); (J.O.C.); (L.M.N.C.); (D.F.H.); (P.F.C.V.)
| | - Pedro F. C. Vasconcelos
- Department of Arbovirology & Hemorrhagic Fever, Evandro Chagas Institute, Ananindeua 67015-120, PA, Brazil; (A.F.M.); (T.R.S.); (M.H.R.d.M.); (L.L.d.C.); (F.A.e.S.); (R.S.S.A.); (E.V.P.d.S.); (L.C.M.); (J.O.C.); (L.M.N.C.); (D.F.H.); (P.F.C.V.)
- Science and Health Institute, Pará State University, Belém 66113-010, PA, Brazil
| | - Rommel M. R. Burbano
- Biological Sciences Institute, ICS, Federal University of Pará, Belém 66050-000, PA, Brazil;
| | - Pei-Yong Shi
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch, Galveston, TX 77550, USA; (J.G.C.N.); (B.T.D.N.); (C.S.); (P.-Y.S.)
| | - Daniele B. A. Medeiros
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch, Galveston, TX 77550, USA; (J.G.C.N.); (B.T.D.N.); (C.S.); (P.-Y.S.)
- Post Graduation Program in Parasitary Biology in the Amazon, Belém 66050-540, PA, Brazil
- Department of Arbovirology & Hemorrhagic Fever, Evandro Chagas Institute, Ananindeua 67015-120, PA, Brazil; (A.F.M.); (T.R.S.); (M.H.R.d.M.); (L.L.d.C.); (F.A.e.S.); (R.S.S.A.); (E.V.P.d.S.); (L.C.M.); (J.O.C.); (L.M.N.C.); (D.F.H.); (P.F.C.V.)
| |
Collapse
|
8
|
Sangkaew S, Ming D, Boonyasiri A, Honeyford K, Kalayanarooj S, Yacoub S, Dorigatti I, Holmes A. Risk predictors of progression to severe disease during the febrile phase of dengue: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2021; 21:1014-1026. [PMID: 33640077 PMCID: PMC8240557 DOI: 10.1016/s1473-3099(20)30601-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 05/01/2020] [Accepted: 06/30/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND The ability to accurately predict early progression of dengue to severe disease is crucial for patient triage and clinical management. Previous systematic reviews and meta-analyses have found significant heterogeneity in predictors of severe disease due to large variation in these factors during the time course of the illness. We aimed to identify factors associated with progression to severe dengue disease that are detectable specifically in the febrile phase. METHODS We did a systematic review and meta-analysis to identify predictors identifiable during the febrile phase associated with progression to severe disease defined according to WHO criteria. Eight medical databases were searched for studies published from Jan 1, 1997, to Jan 31, 2020. Original clinical studies in English assessing the association of factors detected during the febrile phase with progression to severe dengue were selected and assessed by three reviewers, with discrepancies resolved by consensus. Meta-analyses were done using random-effects models to estimate pooled effect sizes. Only predictors reported in at least four studies were included in the meta-analyses. Heterogeneity was assessed using the Cochrane Q and I2 statistics, and publication bias was assessed by Egger's test. We did subgroup analyses of studies with children and adults. The study is registered with PROSPERO, CRD42018093363. FINDINGS Of 6643 studies identified, 150 articles were included in the systematic review, and 122 articles comprising 25 potential predictors were included in the meta-analyses. Female patients had a higher risk of severe dengue than male patients in the main analysis (2674 [16·2%] of 16 481 vs 3052 [10·5%] of 29 142; odds ratio [OR] 1·13 [95% CI 1·01-1·26) but not in the subgroup analysis of studies with children. Pre-existing comorbidities associated with severe disease were diabetes (135 [31·3%] of 431 with vs 868 [16·0%] of 5421 without; crude OR 4·38 [2·58-7·43]), hypertension (240 [35·0%] of 685 vs 763 [20·6%] of 3695; 2·19 [1·36-3·53]), renal disease (44 [45·8%] of 96 vs 271 [16·0%] of 1690; 4·67 [2·21-9·88]), and cardiovascular disease (nine [23·1%] of 39 vs 155 [8·6%] of 1793; 2·79 [1·04-7·50]). Clinical features during the febrile phase associated with progression to severe disease were vomiting (329 [13·5%] of 2432 with vs 258 [6·8%] of 3797 without; 2·25 [1·87-2·71]), abdominal pain and tenderness (321 [17·7%] of 1814 vs 435 [8·1%] of 5357; 1·92 [1·35-2·74]), spontaneous or mucosal bleeding (147 [17·9%] of 822 vs 676 [10·8%] of 6235; 1·57 [1·13-2·19]), and the presence of clinical fluid accumulation (40 [42·1%] of 95 vs 212 [14·9%] of 1425; 4·61 [2·29-9·26]). During the first 4 days of illness, platelet count was lower (standardised mean difference -0·34 [95% CI -0·54 to -0·15]), serum albumin was lower (-0·5 [-0·86 to -0·15]), and aminotransferase concentrations were higher (aspartate aminotransferase [AST] 1·06 [0·54 to 1·57] and alanine aminotransferase [ALT] 0·73 [0·36 to 1·09]) among individuals who progressed to severe disease. Dengue virus serotype 2 was associated with severe disease in children. Secondary infections (vs primary infections) were also associated with severe disease (1682 [11·8%] of 14 252 with vs 507 [5·2%] of 9660 without; OR 2·26 [95% CI 1·65-3·09]). Although the included studies had a moderate to high risk of bias in terms of study confounding, the risk of bias was low to moderate in other domains. Heterogeneity of the pooled results varied from low to high on different factors. INTERPRETATION This analysis supports monitoring of the warning signs described in the 2009 WHO guidelines on dengue. In addition, testing for infecting serotype and monitoring platelet count and serum albumin, AST, and ALT concentrations during the febrile phase of illness could improve the early prediction of severe dengue. FUNDING Wellcome Trust, National Institute for Health Research, Collaborative Project to Increase Production of Rural Doctors, and Royal Thai Government.
Collapse
Affiliation(s)
- Sorawat Sangkaew
- Section of Adult Infectious Disease, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK; Department of Social Medicine, Hatyai Hospital, Songkhla, Thailand.
| | - Damien Ming
- Section of Adult Infectious Disease, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Adhiratha Boonyasiri
- Section of Adult Infectious Disease, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Kate Honeyford
- Global Digital Health Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Siripen Kalayanarooj
- Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Sophie Yacoub
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Ilaria Dorigatti
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Alison Holmes
- Section of Adult Infectious Disease, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK; Antimicrobial Resistance Collaborative, Imperial College London, London, UK
| |
Collapse
|
9
|
Abstract
INTRODUCTION Changing dengue epidemiological trends have resulted in a shift in the disease burden to the adult population. Older adults suffer from poorer outcomes as compared to their younger counterparts, making clinical management of this sub-population particularly challenging. Areas covered: We present a review of the current literature on the changing epidemiology of dengue in the elderly, the atypical features of the clinical disease in this population with emphasis on severe disease presentations and challenges in the current management strategies. Expert commentary: Dengue in the elderly is an increasingly important yet greatly understudied area. There is an urgent need to refine the current diagnostic criteria to improve diagnosis, classification of disease severity and identify individuals in this population who are likely to progress to severe disease. Management strategies in this population would have to be adjusted to account for the increased number of co-morbidities. The role of the available dengue vaccines in this group is uncertain, and more studies into their safety and efficacy are critically needed.
Collapse
Affiliation(s)
- Ray Junhao Lin
- a Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology , Tan Tock Seng Hospital , Singapore
| | - Tau Hong Lee
- a Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology , Tan Tock Seng Hospital , Singapore
| | - Yee Sin Leo
- a Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology , Tan Tock Seng Hospital , Singapore.,b Saw Swee Hock School of Public Health , National University of Singapore , Singapore.,c Lee Kong Chian School of Medicine , Nanyang Technological University , Singapore
| |
Collapse
|