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Chen W, Chen Y, Aslam MS, Shen J, Tong T, Yan S, Cheng W, Huang Z, Li J, Liu S, Li J, Zeng J, Li M, You Z, Meng X. The effect of acupuncture on lateral habenular nucleus and intestinal microflora in depression model rats. Behav Brain Res 2023; 455:114627. [PMID: 37619770 DOI: 10.1016/j.bbr.2023.114627] [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: 05/01/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Depression is a severe emotional condition that significantly affects the quality of life. Acupuncture exerts preventive effects on depression in rats with post-chronic unpredictable mild stress (CUMS). Methods The study involved chronic unpredictable mild stress (CUMS) depression model mice to administer acupuncture as a preventative measure to investigate the mechanism of acupuncture's antidepressant and observe the effect of acupuncture on impact via the Lateral Habenula (LHb) and Gut-Liver-Brain Axis. The researcher investigated molecules correlating with a nitric oxide/cyclic guanosine monophosphate (NO/cGMP) pathway and assessed inflammation in the LHb and liver. In addition, 16 S rDNA bioinformatics study revealed the quantity and variety of gut microbiota. Rats were randomly divided into five groups: control (CON), CUMS, CUMS + acupuncture (AP), CUMS + fluoxetine (FX) and CUMS + N(G) -nitro -L- arginine methyl ester (LNAME) group. Except for the CON group, other rats were exposed to CUMS condition for 28 days. Simultaneously, manual acupuncture (at Fengfu and Shangxing acupoints, once every other day) and fluoxetine gavage (2.1 mg/kg, 0.21 mg/mL, daily) were conducted to the groups of AP and FX, respectively, after stressors. Rats in LNAME group were treated with LNAME normal saline (10 mg/kg, 1 mg/mL, i.p.) solution. Behavioural tests and biological detection methods were conducted sequentially to evaluate depressionlike phenotype in rats. RESULTS The results showed CUMS induced depression-like behaviours, hyper-activation of NO/cGMP signaling pathway, inflammation in serum, LHb and liver, and dysbiosis of the gut microbiota. These changes could be prevented and ameliorated by acupuncture to varying extents. CONCLUSION Acupuncture prevented and attenuated depression-like phenotype induced by CUMS, possibly via regulating the NO/cGMP signaling pathway and thus improving inflammation in serum, LHb and liver, and gut microbiota dysbiosis. In addition, these can be evidence of the existence of the gut-liver-brain axis.
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Affiliation(s)
- Wenjie Chen
- Department of Traditional Chinese Medicine, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
| | - Yiping Chen
- First Clinical College, Yunnan University of Chinese Medicine, Kunming, Yunnan, PR China
| | | | - Junliang Shen
- Department of Traditional Chinese Medicine, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
| | - Tao Tong
- Second Clinical College, Shanxi University of Traditional Chinese Medicine, Taiyuan, Shanxi, PR China
| | - Simin Yan
- Department of Traditional Chinese Medicine, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
| | - Wenjing Cheng
- Department of Rehabilitation Medicine, Ezhou Central Hospital, Ezhou, Hubei, PR China
| | - Zichun Huang
- Department of Traditional Chinese Medicine, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
| | - Jiawei Li
- Department of Traditional Chinese Medicine, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
| | - Siyu Liu
- Department of Acupuncture, Longyan Hospital of Traditional Chinese Medicine, Longyan, Fujian, PR China
| | - Jianguo Li
- Second Clinical College, Shanxi University of Traditional Chinese Medicine, Taiyuan, Shanxi, PR China
| | - Jingyu Zeng
- Department of Traditional Chinese Medicine, School of Medicine, Xiamen University, Xiamen, Fujian, PR China
| | - Meng Li
- Second Clinical College, Shanxi University of Traditional Chinese Medicine, Taiyuan, Shanxi, PR China
| | - Zhuoran You
- Second Clinical College, Shanxi University of Traditional Chinese Medicine, Taiyuan, Shanxi, PR China
| | - Xianjun Meng
- Department of Traditional Chinese Medicine, School of Medicine, Xiamen University, Xiamen, Fujian, PR China; Traditional Chinese Medicine Foundation of Xiamen, Xiamen, Fujian, PR. China.
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Ribeiro AF, Cavalin RF, Klimas AMM, Manfredo R, Borges LMS. Accuracy of yellow fever case definition of epidemiologic surveillance, São Paulo, 2018. Rev Saude Publica 2023; 57:46. [PMID: 37556668 PMCID: PMC10355313 DOI: 10.11606/s1518-8787.2023057005001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 12/13/2022] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE To evaluate the accuracy of yellow fever (YF) suspected case definitions from the Brazilian Ministry of Health (BMH) and World Health Organization (WHO), as well as propose and evaluate new definitions of suspected cases, considering confirmed and discarded cases. METHODS The retrospective study was conducted at the Instituto de Infectologia Emílio Ribas (IIER), using the Epidemiologic Surveillance Form of YF cases. From the confirmed and discarded cases of YF, a logistic regression model was developed. The independent variables were used in a proposed definition of a suspected case of YF and its accuracy was evaluated. RESULTS In total, 113 YF suspect cases were reported, with 78 confirmed (69.0%). The definitions by BMH and WHO presented low sensitivity, 59% and 53.8%, and reduced accuracy, 53.1% and 47.8%, respectively. Predictive factors for YF were thrombocytopenia, leukopenia, and elevation of transaminases greater than twice normal. The definition including individual with acute onset of fever, followed by elevation of ALT or AST greater than twice the reference value AND leukopenia OR thrombocytopenia presented high sensitivity (88.3%), specificity (62.9%), and the best accuracy (80.4%), as proposed in the model. CONCLUSION The YF suspected case definitions of the BMH and the WHO have low sensitivity. The inclusion of nonspecific laboratory tests increases the accuracy of YF definition.
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Affiliation(s)
- Ana Freitas Ribeiro
- Secretaria de Estado da Saúde de São PauloInstituto de Infectologia Emílio RibasSão PauloSPBrasilSecretaria de Estado da Saúde de São Paulo. Instituto de Infectologia Emílio Ribas. São Paulo, SP, Brasil
- Universidade Municipal de São Caetano do SulFaculdade de MedicinaSão PauloSPBrasilUniversidade Municipal de São Caetano do Sul. Faculdade de Medicina. São Paulo, SP, Brasil
| | - Roberta Figueiredo Cavalin
- Secretaria de Estado da Saúde de São PauloInstituto de Infectologia Emílio RibasSão PauloSPBrasilSecretaria de Estado da Saúde de São Paulo. Instituto de Infectologia Emílio Ribas. São Paulo, SP, Brasil
- Universidade Municipal de São Caetano do SulFaculdade de MedicinaSão PauloSPBrasilUniversidade Municipal de São Caetano do Sul. Faculdade de Medicina. São Paulo, SP, Brasil
| | - Aparecida Mei Mingrone Klimas
- Secretaria de Estado da Saúde de São PauloInstituto de Infectologia Emílio RibasSão PauloSPBrasilSecretaria de Estado da Saúde de São Paulo. Instituto de Infectologia Emílio Ribas. São Paulo, SP, Brasil
| | - Ricardo Manfredo
- Secretaria de Estado da Saúde de São PauloInstituto de Infectologia Emílio RibasSão PauloSPBrasilSecretaria de Estado da Saúde de São Paulo. Instituto de Infectologia Emílio Ribas. São Paulo, SP, Brasil
| | - Luciana Marques Sansão Borges
- Secretaria de Estado da Saúde de São PauloInstituto de Infectologia Emílio RibasSão PauloSPBrasilSecretaria de Estado da Saúde de São Paulo. Instituto de Infectologia Emílio Ribas. São Paulo, SP, Brasil
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Evaluation of Whatman FTA cards for the preservation of yellow fever virus RNA for use in molecular diagnostics. PLoS Negl Trop Dis 2022; 16:e0010487. [PMID: 35704565 PMCID: PMC9200311 DOI: 10.1371/journal.pntd.0010487] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/10/2022] [Indexed: 12/31/2022] Open
Abstract
Yellow fever virus (YFV) is a flavivirus that frequently causes outbreaks of hemorrhagic fever in Africa and South America and is considered a reemerging public health threat. Accurate diagnosis of yellow fever (YF) disease is critical as one confirmed case constitutes an outbreak and may trigger a mass vaccination campaign. Highly sensitive and specific molecular diagnostics have been developed; however, these assays require maintenance of cold-chain during transport of specimens to prevent the degradation of viral RNA prior to testing. Such cold-chain requirements are difficult to meet in some regions. In this study, we investigated Whatman FTA cards as an alternative stabilization method of YFV RNA for use in molecular diagnosis. Using contrived specimens, linear regression analysis showed that RNA detection from a single 6mm FTA card punch was significantly less sensitive than traditional RNA extraction; however, pooling RNA extracted from two FTA punches significantly lowered the limit of detection to be equal to that of the traditional RNA extraction gold standard. In experiments addressing the ability of FTA card methodology to stabilize YFV RNA at variable temperature, RNA could be detected for more than two weeks following storage at 25°C. Even more promising, YFV RNA was detectable on cards held at 37°C from two days to over two weeks depending on viral input. FTA cards were also shown to stabilize YFV RNA at high humidity if cards were desiccated prior to inoculation. These results support that FTA cards could be cost effective and easy to use in molecular diagnosis of YF, preserving viral RNA to allow for positive diagnoses in situations where maintaining cold-chain is not feasible.
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Moreira Salles AP, de Seixas Santos Nastri AC, Ho YL, Vilas Boas Casadio L, Emanuel Amgarten D, Justo Arévalo S, Soares Gomes-Gouvea M, Jose Carrilho F, de Mello Malta F, Rebello Pinho JR. Updating the Phylodynamics of Yellow Fever Virus 2016-2019 Brazilian Outbreak With New 2018 and 2019 São Paulo Genomes. Front Microbiol 2022; 13:811318. [PMID: 35633726 PMCID: PMC9132216 DOI: 10.3389/fmicb.2022.811318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/16/2022] [Indexed: 11/19/2022] Open
Abstract
The recent outbreak of yellow fever (YF) in São Paulo during 2016-2019 has been one of the most severe in the last decades, spreading to areas with low vaccine coverage. The aim of this study was to assess the genetic diversity of the yellow fever virus (YFV) from São Paulo 2016-2019 outbreak, integrating the available genomic data with new genomes from patients from the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). Using phylodynamics, we proposed the existence of new IE subclades, described their sequence signatures, and determined their locations and time of origin. Plasma or urine samples from acute severe YF cases (n = 56) with polymerase chain reaction (PCR) positive to YFV were submitted to viral genome amplification using 12 sets of primers. Thirty-nine amplified genomes were subsequently sequenced using next-generation sequencing (NGS). These 39 sequences, together with all the complete genomes publicly available, were aligned and used to determine nucleotide/amino acids substitutions and perform phylogenetic and phylodynamic analysis. All YFV genomes generated in this study belonged to the genotype South American I subgroup E. Twenty-one non-synonymous substitutions were identified among the new generated genomes. We analyzed two major clades of the genotypes IE, IE1, and IE2 and proposed the existence of subclades based on their sequence signatures. Also, we described the location and time of origin of these subclades. Overall, our findings provide an overview of YFV genomic characterization and phylodynamics of the 2016-2019 outbreak contributing to future virological and epidemiological studies.
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Affiliation(s)
- Ana Paula Moreira Salles
- Department of Gastroenterology (LIM07), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Clinical Laboratory of Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Yeh-Li Ho
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luciana Vilas Boas Casadio
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Deyvid Emanuel Amgarten
- Clinical Laboratory of Hospital Israelita Albert Einstein, São Paulo, Brazil
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, São Paulo, Brazil
| | - Santiago Justo Arévalo
- Clinical Laboratory of Hospital Israelita Albert Einstein, São Paulo, Brazil
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, São Paulo, Brazil
- Facultad de Ciencias Biológicas, Universidad Ricardo Palma, Lima, Peru
| | | | - Flair Jose Carrilho
- Department of Gastroenterology (LIM07), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda de Mello Malta
- Department of Gastroenterology (LIM07), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Clinical Laboratory of Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - João Renato Rebello Pinho
- Department of Gastroenterology (LIM07), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Clinical Laboratory of Hospital Israelita Albert Einstein, São Paulo, Brazil
- Division of Clinical Laboratories (LIM 03), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Arantes MF, Seabra VF, Lins PRG, Rodrigues CE, Reichert BV, Silveira MAD, Li HY, Malbouisson LM, Andrade L. Risk Factors for Acute Kidney Injury and Death in Patients Infected With the Yellow Fever Virus During the 2018 Outbreak in São Paulo, Brazil. Kidney Int Rep 2021; 7:601-609. [PMID: 35257072 PMCID: PMC8897308 DOI: 10.1016/j.ekir.2021.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/23/2021] [Accepted: 12/13/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction Methods Results Conclusion
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Affiliation(s)
- Márcia Fernanda Arantes
- Division of Nephrology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Victor Faria Seabra
- Division of Nephrology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Paulo Ricardo Gessolo Lins
- Division of Nephrology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Camila Eleuterio Rodrigues
- Division of Nephrology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Bernardo Vergara Reichert
- Division of Nephrology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Ho Yeh Li
- Intensive Care Unit, Department of Infectious and Parasitic Diseases, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Luiz Marcelo Malbouisson
- Division of Anesthesiology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Lúcia Andrade
- Division of Nephrology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
- Correspondence: Lúcia Andrade, Division of Nephrology, Hospital das Clínicas, University of São Paulo School of Medicine, Av. Dr. Arnaldo, 455, 3 andar, sala 3310, São Paulo, SP 01246-903, Brazil.
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Neves YCS, de Castro-Lima VAC, Solla DJF, Ogata VSDM, Pereira FL, Araujo JM, Nastri ACS, Ho YL, Chammas MC. Staging liver fibrosis after severe yellow fever with ultrasound elastography in Brazil: A six-month follow-up study. PLoS Negl Trop Dis 2021; 15:e0009594. [PMID: 34283826 PMCID: PMC8323872 DOI: 10.1371/journal.pntd.0009594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/30/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Yellow fever (YF) is a hemorrhagic disease caused by an arbovirus endemic in South America, with recent outbreaks in the last years. Severe cases exhibit fulminant hepatitis, but there are no studies regarding its late-term effects on liver parenchyma. Thus, the aim of this study was to determine the frequency and grade of liver fibrosis in patients who recovered from severe YF and to point out potential predictors of this outcome. METHODOLOGY/PRINCIPAL FINDINGS We followed-up 18 patients who survived severe YF during a recent outbreak (January-April 2018) in Brazil using ultrasound (US) with shear-wave elastography (SWE) at 6 months after symptoms onset. No patient had previous history of liver disease. Median liver stiffness (LS) was 5.3 (4.6-6.4) kPa. 2 (11.1%) patients were classified as Metavir F2, 1 (8.3%) as F3 and 1 (8.3%) as F4; these two last patients had features of cardiogenic liver congestion on Doppler analysis. Age and cardiac failure were associated with increased LS (p = 0.036 and p = 0.024, respectively). SAPS-3 at ICU admission showed a tendency of association with significant fibrosis (≥ F2; p = 0.053). 7 patients used sofosbuvir in a research protocol, of which none showed liver fibrosis (p = 0.119). CONCLUSIONS/SIGNIFICANCE We found a low frequency of liver fibrosis in severe YF survivors. US with SWE may have a role in the follow up of patients of age and / or with comorbidities after hospital discharge in severe YF, a rare but reemergent disease.
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Affiliation(s)
- Yuri Costa Sarno Neves
- Radiology Institute, Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | | | - Davi Jorge Fontoura Solla
- Department of Neurology, Division of Neurosurgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Vivian Simone de Medeiros Ogata
- Radiology Institute, Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Fernando Linhares Pereira
- Radiology Institute, Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Jordana Machado Araujo
- Department and Division of Infectious and Parasitic Diseases, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Ana Catharina Seixas Nastri
- Department and Division of Infectious and Parasitic Diseases, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Yeh-Li Ho
- Department and Division of Infectious and Parasitic Diseases, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Maria Cristina Chammas
- Radiology Institute, Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, University of Sao Paulo, São Paulo, Brazil
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Puerarin enhances intestinal function in piglets infected with porcine epidemic diarrhea virus. Sci Rep 2021; 11:6552. [PMID: 33753826 PMCID: PMC7985190 DOI: 10.1038/s41598-021-85880-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/02/2021] [Indexed: 12/12/2022] Open
Abstract
Puerarin has been reported to be an excellent antioxidant, anti-inflammatory and antimicrobial agent, but the potential effect of puerarin on porcine epidemic diarrhea virus (PEDV) is unclear. This study aimed to determine whether puerarin could alleviate intestinal injury in piglets infected with PEDV. A PEDV (Yunnan province strain) infection model was applied to 7-day-old piglets at 104.5 TCID50 (50% tissue culture infectious dose). Piglets were orally administered with puerarin at the dosage of 0.5 mg/kg body weight from day 5 to day 9. On day 9 of the trial, piglets were inoculated orally with PEDV. Three days later, jugular vein blood and intestinal samples were collected. Results showed puerarin reduced morbidity of piglets infected with PEDV. In addition, puerarin reduced the activities of aspartate aminotransferase and alkaline phosphatase, the ratio of serum aspartate aminotransferase to serum alanine aminotransferase, the number of white blood cells and neutrophils, and the plasma concentrations of interleukin-6, interleukin-8 and tumor necrosis factor-α, as well as protein abundances of heat shock protein-70 in PEDV-infected piglets. Moreover, puerarin increased D-xylose concentration but decreased intestinal fatty acid-binding protein concentration and diamine oxidase activity in the plasma of piglets infected with PEDV. Puerarin increased the activities of total superoxide dismutase, glutathione peroxidase and catalase, while decreasing the activities of myeloperoxidase and concentration of hydrogen peroxide in both the intestine and plasma of PEDV-infected piglets. Puerarin decreased mRNA levels of glutathione S-transferase omega 2 but increased the levels of nuclear factor erythroid 2-related factor 2. Furthermore, puerarin increased the abundance of total eubacteria (16S rRNA), Enterococcus genus, Lactobacillus genus and Enterobacteriaceae family in the intestine, but reduced the abundance of Clostridium coccoides in the caecum. These data indicate puerarin improved intestinal function in piglets infected by PEDV and may be a promising supplement for the prevention of PEDV infection.
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Ultrasound Findings and Laboratory Predictors of Early Mortality in Patients With Severe Yellow Fever. AJR Am J Roentgenol 2021; 216:1392-1399. [PMID: 33703928 DOI: 10.2214/ajr.20.23455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE. Yellow fever is a hemorrhagic disease caused by an arbovirus endemic in South America; outbreaks have occurred in recent years. The purpose of this study was to describe abdominal ultrasound findings in patients with severe yellow fever and correlate them with clinical and laboratory data. MATERIALS AND METHODS. A retrospective cohort study was performed between January and April 2018. The subjects were patients admitted to an ICU with polymerase chain reaction-confirmed yellow fever. Bedside sonography was performed within 48 hours of admission. Images were independently analyzed by two board-certified radiologists. Laboratory test samples were collected within 12 hours of image acquisition. Multivariable logistic regression analysis was performed to identify 30-day mortality predictors; p < .05 was considered statistically significant. RESULTS. Forty-six patients (40 [87%] men, six [13%] women; mean age, 47.5 ± 15.2 years) were evaluated with bedside sonography. Laboratory tests showed high serum levels of aspartate aminotransferase (5319 U/L), total bilirubin (6.2 mg/dL), and creati-nine (4.3 mg/dL). Twenty-six (56.5%) patients died within 30 days of admission (median time to death, 5 days [interquartile range, 2-9 days]). The most frequent ultrasound findings were gallbladder wall thickening (80.4%), increased renal cortex echogenicity (71.7%), increased liver parenchyma echogenicity (65.2%), perirenal fluid (52.2%), and ascites (30.4%). Increased renal echogenicity was associated with 30-day mortality (84.6% versus 55.0%; p = .046) and was an independent predictor of this outcome after multivariate analysis (odds ratio, 10.89; p = .048). CONCLUSION. Reproducible abdominal ultrasound findings in patients with severe yellow fever may be associated with severity of disease and prognosis among patients treated in the ICU.
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Mendes ÉA, Pilger DRBD, Santos Nastri ACDS, Malta FDM, Pascoalino BDS, Carneiro D'Albuquerque LA, Balan A, Freitas LHGD, Durigon EL, Carrilho FJ, Rebello Pinho JR. Sofosbuvir inhibits yellow fever virus in vitro and in patients with acute liver failure. Ann Hepatol 2020; 18:816-824. [PMID: 31594756 DOI: 10.1016/j.aohep.2019.09.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/11/2019] [Accepted: 09/17/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Direct antiviral agents (DAAs) are very efficient in inhibiting hepatitis C virus and might be used to treat infections caused by other flaviviruses whose worldwide detection has recently increased. The aim of this study was to verify the efficacy of DAAs in inhibiting yellow fever virus (YFV) by using drug repositioning (a methodology applied in the pharmaceutical industry to identify new uses for approved drugs). MATERIALS AND METHODS Three DAAs were evaluated: daclatasvir, sofosbuvir and ledipasvir or their combinations. For in vitro assays, the drugs were diluted in 100% dimethyl sulfoxide. Vaccine strain 17D and a 17D strain expressing the reporter fluorescent protein were used in the assays. A fast and reliable cell-based screening assay using Vero cells or Huh-7 cells (a hepatocyte-derived carcinoma ell line) was carried out. Two patients who acquired yellow fever virus with acute liver failure were treated with sofosbuvir for one week as a compassionate use. RESULTS Using a high-content screening assay, we verified that sofosbuvir presented the best antiviral activity against YFV. Moreover, after an off-label treatment with sofosbuvir, the two female patients diagnosed with yellow fever infection displayed a reduction in blood viremia and an improvement in the course of the disease, which was observed in the laboratory medical parameters related to disease evolution. CONCLUSIONS Sofosbuvir may be used as an option for treatment against YFV until other drugs are identified and approved for human use. These results offer insights into the role of nonstructural protein 5 (NS5) in YFV inhibition and suggest that nonstructural proteins may be explored as drug targets for YFV treatment.
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Affiliation(s)
- Érica Araújo Mendes
- Department of Microbiology, University of São Paulo Biomedical Sciences Institute, São Paulo, Brazil
| | - Denise Regina Bairros de Pilger
- Department of Microbiology, University of São Paulo Biomedical Sciences Institute, São Paulo, Brazil; Butantan Institute, São Paulo, Brazil
| | - Ana Catharina de Seixas Santos Nastri
- Department of Parasitic and Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil; LIM-07, Institute of Tropical Medicine, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Fernanda de Mello Malta
- LIM-07, Institute of Tropical Medicine, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | | | - Andrea Balan
- Department of Microbiology, University of São Paulo Biomedical Sciences Institute, São Paulo, Brazil
| | - Lucio Holanda Gondim de Freitas
- Department of Microbiology, University of São Paulo Biomedical Sciences Institute, São Paulo, Brazil; Butantan Institute, São Paulo, Brazil
| | - Edison Luis Durigon
- Department of Microbiology, University of São Paulo Biomedical Sciences Institute, São Paulo, Brazil
| | - Flair José Carrilho
- LIM-07, Institute of Tropical Medicine, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - João Renato Rebello Pinho
- Hospital Israelita Albert Einstein, São Paulo, Brazil; LIM-03, Central Laboratories Division, Clinics Hospital, São Paulo School of Medicine, University of São Paulo, São Paulo, Brazil; LIM-07, Institute of Tropical Medicine, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil.
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A Yellow Fever Virus 17D Infection and Disease Mouse Model Used to Evaluate a Chimeric Binjari-Yellow Fever Virus Vaccine. Vaccines (Basel) 2020; 8:vaccines8030368. [PMID: 32660106 PMCID: PMC7564786 DOI: 10.3390/vaccines8030368] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/04/2020] [Accepted: 07/07/2020] [Indexed: 12/19/2022] Open
Abstract
Despite the availability of an effective, live attenuated yellow fever virus (YFV) vaccine (YFV 17D), this flavivirus still causes up to ≈60,000 deaths annually. A number of new approaches are seeking to address vaccine supply issues and improve safety for the immunocompromised vaccine recipients. Herein we describe an adult female IFNAR-/- mouse model of YFV 17D infection and disease that recapitulates many features of infection and disease in humans. We used this model to evaluate a new YFV vaccine that is based on a recently described chimeric Binjari virus (BinJV) vaccine technology. BinJV is an insect-specific flavivirus and the chimeric YFV vaccine (BinJ/YFV-prME) was generated by replacing the prME genes of BinJV with the prME genes of YFV 17D. Such BinJV chimeras retain their ability to replicate to high titers in C6/36 mosquito cells (allowing vaccine production), but are unable to replicate in vertebrate cells. Vaccination with adjuvanted BinJ/YFV-prME induced neutralizing antibodies and protected mice against infection, weight loss and liver pathology after YFV 17D challenge.
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Casadio L, Nastri AC, Malta FM, Araujo J, Silva JB, Salomao J, Yamashiro J, Salles AP, Gouvea MG, Kanamura C, Lima FR, Tanigawa RY, Melo ES, Lima R, Terrabuio D, Cançado E, Ho YL, Sabino EC, Pinho JR, Carrilho FJ, Alves VA, Levin AS. Late-Onset Relapsing Hepatitis Associated with Yellow Fever. N Engl J Med 2020; 382:2059-2061. [PMID: 32433844 DOI: 10.1056/nejmc1913036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Roque Lima
- Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Yeh-Li Ho
- Universidade de São Paulo, São Paulo, Brazil
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12
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Silva NIO, Sacchetto L, de Rezende IM, Trindade GDS, LaBeaud AD, de Thoisy B, Drumond BP. Recent sylvatic yellow fever virus transmission in Brazil: the news from an old disease. Virol J 2020; 17:9. [PMID: 31973727 PMCID: PMC6979359 DOI: 10.1186/s12985-019-1277-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/27/2019] [Indexed: 12/11/2022] Open
Abstract
Yellow fever (YF) is an acute viral disease, affecting humans and non-human primates (NHP), caused by the yellow fever virus (YFV). Despite the existence of a safe vaccine, YF continues to cause morbidity and mortality in thousands of people in Africa and South America. Since 2016, massive YF outbreaks have taken place in Brazil, reaching YF-free zones, causing thousands of deaths of humans and NHP. Here we reviewed the main epidemiological aspects, new clinical findings in humans, and issues regarding YFV infection in vectors and NHP in Brazil. The 2016-2019 YF epidemics have been considered the most significant outbreaks of the last 70 years in the country, and the number of human cases was 2.8 times higher than total cases in the previous 36 years. A new YFV lineage was associated with the recent outbreaks, with persistent circulation in Southeast Brazil until 2019. Due to the high number of infected patients, it was possible to evaluate severity and death predictors and new clinical features of YF. Haemagogus janthinomys and Haemagogus leucocelaenus were considered the primary vectors during the outbreaks, and no human case suggested the occurrence of the urban transmission cycle. YFV was detected in a variety of NHP specimens presenting viscerotropic disease, similar to that described experimentally. Further studies regarding NHP sensitivity to YFV, YF pathogenesis, and the duration of the immune response in NHP could contribute to YF surveillance, control, and future strategies for NHP conservation.
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Affiliation(s)
- Natalia Ingrid Oliveira Silva
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lívia Sacchetto
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Izabela Maurício de Rezende
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Giliane de Souza Trindade
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Angelle Desiree LaBeaud
- Division of Infectious Disease, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Benoit de Thoisy
- Laboratoire des Interactions Virus-Hôtes, Institut Pasteur de la Guyane, Cayenne, French Guiana
| | - Betânia Paiva Drumond
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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13
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Disease Resurgence, Production Capability Issues and Safety Concerns in the Context of an Aging Population: Is There a Need for a New Yellow Fever Vaccine? Vaccines (Basel) 2019; 7:vaccines7040179. [PMID: 31717289 PMCID: PMC6963298 DOI: 10.3390/vaccines7040179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 12/19/2022] Open
Abstract
Yellow fever is a potentially fatal, mosquito-borne viral disease that appears to be experiencing a resurgence in endemic areas in Africa and South America and spreading to non-endemic areas despite an effective vaccine. This trend has increased the level of concern about the disease and the potential for importation to areas in Asia with ecological conditions that can sustain yellow fever virus transmission. In this article, we provide a broad overview of yellow fever burden of disease, natural history, treatment, vaccine, prevention and control initiatives, and vaccine and therapeutic agent development efforts.
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14
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de Sousa MV, Zollner RDL, Stucchi RSB, Boin IDFSF, de Ataide EC, Mazzali M. Yellow fever disease in a renal transplant recipient: Case report and literature review. Transpl Infect Dis 2019; 21:e13151. [PMID: 31344763 DOI: 10.1111/tid.13151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/16/2019] [Accepted: 07/21/2019] [Indexed: 01/20/2023]
Abstract
Yellow fever (YF) is a viral disease, with clinical presentation among immunosuppressed patients not fully understood. YF vaccination (YFV), a live vaccine, is contraindicated in patients receiving immunosuppressive treatment due to the risk of developing the disease after vaccination. We report a case of a 50-year-old male recipient who presented wild-type YF five years after a deceased donor kidney transplant. He lived in a YF endemic area and inadvertently received YFV. One day after YFV, the patient presented nausea, vomiting, fever, diarrhea, polyarthralgia, thrombocytopenia, and increased levels of liver function enzymes. The serological test was compatible with YF disease, and quantitative viral load confirmed the diagnosis of wild-type YF. The patient received supportive care for twelve days, with hospital discharge in good clinical condition and stable renal function. One month after discharge, the patient developed de novo donor-specific anti-HLA antibodies (DSA) and histological evidence of endothelial lesion, with a diagnosis of acute antibody-mediated rejection (AMR), treated with plasmapheresis and human IVIg therapy. Six months after therapy, he presented normal renal function with a reduction of DSA MFI. In the reported case, we observed a clinical wild-type YF diagnosed even after YF vaccine administration, with good clinical outcome. De novo DSA and AMR occurred after the recovering of disease, with an adequate response to therapy and preserved allograft function. We reviewed the published literature on YF and YFV in solid organ transplantation.
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Affiliation(s)
- Marcos Vinicius de Sousa
- Renal Transplant Research Laboratory, Renal Transplant Unit, Division of Nephrology, Department of Internal Medicine, School of Medical Sciences, University of Campinas-UNICAMP, Campinas, Sao Paulo, Brazil.,Laboratory of Translational Immunology, Department of Internal Medicine, School of Medical Sciences, University of Campinas-UNICAMP, Campinas, Sao Paulo, Brazil
| | - Ricardo de Lima Zollner
- Renal Transplant Research Laboratory, Renal Transplant Unit, Division of Nephrology, Department of Internal Medicine, School of Medical Sciences, University of Campinas-UNICAMP, Campinas, Sao Paulo, Brazil.,Laboratory of Translational Immunology, Department of Internal Medicine, School of Medical Sciences, University of Campinas-UNICAMP, Campinas, Sao Paulo, Brazil
| | - Raquel Silveira Bello Stucchi
- Division of Infectious Diseases, Department of Internal Medicine, School of Medical Sciences, University of Campinas-UNICAMP, Campinas, Sao Paulo, Brazil
| | | | - Elaine Cristina de Ataide
- Liver Transplant Unit, Surgery Department, School of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Marilda Mazzali
- Renal Transplant Research Laboratory, Renal Transplant Unit, Division of Nephrology, Department of Internal Medicine, School of Medical Sciences, University of Campinas-UNICAMP, Campinas, Sao Paulo, Brazil.,Laboratory of Translational Immunology, Department of Internal Medicine, School of Medical Sciences, University of Campinas-UNICAMP, Campinas, Sao Paulo, Brazil
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