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de Morais IRB, Barbosa DDO, de Almeida GB, da Costa RR, da Silva BO, de Oliveira LA, Arantes JP, Leite LOC, Rossato L, Ribeiro MB, Marchioro SB, Freire SM, Nascimento RJM, Simionatto S, Torres AJL. Determining reference ranges for immunological cells of healthy indigenous individuals from a region in Brazil. EINSTEIN-SAO PAULO 2023; 21:eAO0291. [PMID: 37878969 PMCID: PMC10567104 DOI: 10.31744/einstein_journal/2023ao0291] [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: 08/30/2022] [Accepted: 04/16/2023] [Indexed: 10/27/2023] Open
Abstract
Morais et al. conducted a pioneering study with Brazilian indigenous populations to determine reference values for immunologic cells from healthy adult individuals. The main findings included a higher relative median for T lymphocyte subsets in females than males, and T CD3+, T CD4+, and T CD8+ relative values were statistically different when compared with Brazilian populations from other Brazilian regions. The relative medians of CD3+, CD4+, and CD8+ T cells were significantly higher in women than in men in a healthy indigenous population. Demographic and ethnic diversity of the Brazilian population can be associated with quantitative modifications in the immunologic cells of healthy individuals. OBJECTIVE The establishment of reference values for a subset of leukocytes is common in clinical practice, and ethnic variations are strongly associated with disease development. In Brazil, indigenous people are vulnerable to infections, and few studies have described the health and disease conditions of this population. This study aimed to provide reference values for immunological cell subsets in indigenous Brazilians living in the state of Mato Grosso do Sul. METHODS Flow cytometry and 4-color combinations of monoclonal antibodies were used to characterize cells. A total of 115 healthy adults, mostly females (72%), were included in the study. The results are presented as mean and median (2.5%-97.5% percentiles) for T and B lymphocytes, CD4+ T cells, CD8+ T cells, Natural Killer cells, monocytes, and dendritic cells, providing an average immunological profile for the population in question. RESULTS The relative medians of CD3+, CD4+, and CD8+ T cells were significantly higher in women than in men in a healthy indigenous population. CONCLUSION To our knowledge, cell reference data from indigenous Brazilians are unknown in the literature. The immune cell results presented in this pioneering study will contribute to the clinical and laboratory evaluation of the Brazilian indigenous population, especially given the important differences when compared with other Brazilian ethnic groups.
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Affiliation(s)
- Isa Rita Brito de Morais
- Universidade Federal da BahiaSalvadorBABrazil Universidade Federal da Bahia , Salvador , BA , Brazil .
| | | | | | - Regina Rossoni da Costa
- Universidade Federal da Grande DouradosDouradosMSBrazil Universidade Federal da Grande Dourados , Dourados , MS , Brazil .
| | - Bruna Oliveira da Silva
- Universidade Federal da Grande DouradosDouradosMSBrazil Universidade Federal da Grande Dourados , Dourados , MS , Brazil .
| | - Laís Albuquerque de Oliveira
- Universidade Federal da Grande DouradosDouradosMSBrazil Universidade Federal da Grande Dourados , Dourados , MS , Brazil .
| | - Julia Pimentel Arantes
- Universidade Federal da Grande DouradosDouradosMSBrazil Universidade Federal da Grande Dourados , Dourados , MS , Brazil .
| | - Layla Oliveira Campos Leite
- Universidade Federal da Grande DouradosDouradosMSBrazil Universidade Federal da Grande Dourados , Dourados , MS , Brazil .
| | - Luana Rossato
- Universidade Federal da Grande DouradosDouradosMSBrazil Universidade Federal da Grande Dourados , Dourados , MS , Brazil .
| | - Marcos Borges Ribeiro
- Universidade Federal da BahiaSalvadorBABrazil Universidade Federal da Bahia , Salvador , BA , Brazil .
| | | | - Songelí Menezes Freire
- Universidade Federal da BahiaSalvadorBABrazil Universidade Federal da Bahia , Salvador , BA , Brazil .
| | | | - Simone Simionatto
- Universidade Federal da BahiaSalvadorBABrazil Universidade Federal da Bahia , Salvador , BA , Brazil .
| | - Alex José Leite Torres
- Universidade Federal da BahiaSalvadorBABrazil Universidade Federal da Bahia , Salvador , BA , Brazil .
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Sabeena S, Chandrabharani K, Ravishankar N, Arunkumar G. Classification of dengue cases in Southwest India based on the WHO systems-a retrospective analysis. Trans R Soc Trop Med Hyg 2018; 112:479-485. [PMID: 30107616 DOI: 10.1093/trstmh/try080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/04/2018] [Indexed: 11/13/2022] Open
Abstract
Background The WHO dengue classification 1997 was revised in 2009 and the revised classification system has now been in use for the past decade. This study was carried out to compare the 1997 and revised classifications in assessing the severity of dengue infection among all age groups during a dengue outbreak in southwest India. Methodology This retrospective cross-sectional study was carried out including serologically confirmed dengue cases. A total of 1033 dengue cases were classified on the basis of the 1997 WHO classification and 2009 revised classification. The statistical analysis was carried out using SPSS 15.0 for Windows (SPSSTM Inc, Chicago, IL, USA). Results Both the 1997 and revised WHO classifications were applied to 1033 confirmed dengue cases, including 692 males (67%) and 341 females (33%). The median age of the study participants was 23 years (IQR 10-33), including 112 (10.8%) children at and below the age of 5 years. The level of agreement between the two systems of classification was poor (kappa=0.143, 0.055-0.198, p-value <0.001). Conclusion A greater sensitivity and specificity of the revised classification was observed in comparison with the 1997 WHO classification. In the context of changing dengue epidemiology and geographical expansion, the revised classification is helpful in the identification of severe cases, facilitating timely management.
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Affiliation(s)
- Sasidharanpillai Sabeena
- Manipal Centre for Virus Research, APEX Referral Laboratory for Arboviruses (NVBDCP), Manipal Academy of Higher Education, Manipal, Karnataka
| | - Kiran Chandrabharani
- Manipal Centre for Virus Research, APEX Referral Laboratory for Arboviruses (NVBDCP), Manipal Academy of Higher Education, Manipal, Karnataka
| | - Nagaraja Ravishankar
- Department of Statistics, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Govindakarnavar Arunkumar
- Manipal Centre for Virus Research, APEX Referral Laboratory for Arboviruses (NVBDCP), Manipal Academy of Higher Education, Manipal, Karnataka
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Wen S, Ma D, Lin Y, Li L, Hong S, Li X, Wang X, Xi J, Qiu L, Pan Y, Chen J, Shan X, Sun Q. Complete Genome Characterization of the 2017 Dengue Outbreak in Xishuangbanna, a Border City of China, Burma and Laos. Front Cell Infect Microbiol 2018; 8:148. [PMID: 29868504 PMCID: PMC5951998 DOI: 10.3389/fcimb.2018.00148] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 04/20/2018] [Indexed: 11/13/2022] Open
Abstract
A dengue outbreak abruptly occurred at the border of China, Myanmar, and Laos in June 2017. By November 3rd 2017, 1184 infected individuals were confirmed as NS1-positivein Xishuangbanna, a city located at the border. To verify the causative agent, complete genome information was obtained through PCR and sequencing based on the viral RNAs extracted from patient samples. Phylogenetic trees were constructed by the maximum likelihood method (MEGA 6.0). Nucleotide and amino acid substitutions were analyzed by BioEdit, followed by RNA secondary structure prediction of untranslated regions (UTRs) and protein secondary structure prediction in coding sequences (CDSs). Strains YN2, YN17741, and YN176272 were isolated from local residents. Stains MY21 and MY22 were isolated from Burmese travelers. The complete genome sequences of the five isolates were 10,735 nucleotides in length. Phylogenetic analysis classified all five isolates as genotype I of DENV-1, while isolates of local residents and Burmese travelers belonged to different branches. The three locally isolates were most similar to the Dongguan strain in 2011, and the other two isolates from Burmese travelers were most similar to the Laos strain in 2008. Twenty-four amino acid substitutions were important in eight evolutionary tree branches. Comparison with DENV-1SS revealed 658 base substitutions in the local isolates, except for two mutations exclusive to YN17741, resulting in 87 synonymous mutations. Compared with the local isolates, 52 amino acid mutations occurred in the CDS of two isolates from Burmese travelers. Comparing MY21 with MY22, 17 amino acid mutations were observed, all these mutations occurred in the CDS of non-structured proteins (two in NS1, 10 in NS2, two in NS3, three in NS5). Secondary structure prediction revealed 46 changes in the potential nucleotide and protein binding sites of the CDSs in local isolates. RNA secondary structure prediction also showed base changes in the 3′UTR of local isolates, leading to two significant changes in the RNA secondary structure. To our knowledge, this study is the first complete genome analysis of isolates from the 2017 dengue outbreak that occurred at the border areas of China, Burma, and Laos.
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Affiliation(s)
- Songjiao Wen
- Institute of Medical Biology, Peking Union Medical College, Chinese Academy of Medical Sciences, Kunming, China.,Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China.,Yunnan Key Laboratory of Vector-borne Infectious Disease, Kunming, China
| | - Dehong Ma
- Xishuangbanna Dai Autonomous Prefecture People's Hospital, Xishuangbanna, China
| | - Yao Lin
- Institute of Medical Biology, Peking Union Medical College, Chinese Academy of Medical Sciences, Kunming, China.,Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China.,Yunnan Key Laboratory of Vector-borne Infectious Disease, Kunming, China
| | - Lihua Li
- Xishuangbanna Dai Autonomous Prefecture People's Hospital, Xishuangbanna, China
| | - Shan Hong
- Institute of Medical Biology, Peking Union Medical College, Chinese Academy of Medical Sciences, Kunming, China.,Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China.,School of Basic Medicine, Kunming Medical University, Kunming, China
| | - Xiaoman Li
- Institute of Pediatric Disease Research, The Affiliated Children's Hospital of Kunming Medical University, Kunming, China
| | - Xiaodan Wang
- Institute of Medical Biology, Peking Union Medical College, Chinese Academy of Medical Sciences, Kunming, China.,Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China.,Yunnan Key Laboratory of Vector-borne Infectious Disease, Kunming, China
| | - Juemin Xi
- Institute of Medical Biology, Peking Union Medical College, Chinese Academy of Medical Sciences, Kunming, China.,Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China.,Yunnan Key Laboratory of Vector-borne Infectious Disease, Kunming, China
| | - Lijuan Qiu
- Institute of Pediatric Disease Research, The Affiliated Children's Hospital of Kunming Medical University, Kunming, China
| | - Yue Pan
- Institute of Medical Biology, Peking Union Medical College, Chinese Academy of Medical Sciences, Kunming, China.,Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China.,Yunnan Key Laboratory of Vector-borne Infectious Disease, Kunming, China
| | - Junying Chen
- Institute of Medical Biology, Peking Union Medical College, Chinese Academy of Medical Sciences, Kunming, China.,Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China.,Yunnan Key Laboratory of Vector-borne Infectious Disease, Kunming, China
| | - Xiyun Shan
- Xishuangbanna Dai Autonomous Prefecture People's Hospital, Xishuangbanna, China
| | - Qiangming Sun
- Institute of Medical Biology, Peking Union Medical College, Chinese Academy of Medical Sciences, Kunming, China.,Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China.,Yunnan Key Laboratory of Vector-borne Infectious Disease, Kunming, China
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Sacramento RHM, de Carvalho Araújo FM, Lima DM, Alencar CCH, Martins VEP, Araújo LV, de Oliveira TC, de Góes Cavalcanti LP. Dengue Fever andAedes aegyptiin indigenous Brazilians: seroprevalence, risk factors, knowledge and practices. Trop Med Int Health 2018; 23:596-604. [DOI: 10.1111/tmi.13061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Rafael Henrique Machado Sacramento
- Equipe Indígena de Saúde do Ministério da Saúde; Fortaleza Brazil
- Programa de Pós-graduação em Patologia; Universidade Federal do Ceará; Fortaleza Brazil
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Dias JDJ, Branco MDRFC, Queiroz RCDS, dos Santos AM, Moreira EPB, da Silva MDS. Analysis of dengue cases according to clinical severity, São Luís, Maranhão, Brazil. Rev Inst Med Trop Sao Paulo 2017; 59:e71. [PMID: 29116291 PMCID: PMC5679683 DOI: 10.1590/s1678-9946201759071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/29/2017] [Indexed: 11/22/2022] Open
Abstract
Severe dengue cases have increased in Brazil since 2001, with the first records in Maranhão dating back to 2002. The aim of this study was to determine the prevalence of severe dengue cases by age group and the possible risk factors. This was a study of secondary data on dengue in residents of São Luís, Maranhão, Brazil, using probable cases notified to the National Mandatory Reporting System (SINAN) from 2002 to 2011. The diagnosis and classification of dengue were based on the Brazilian Ministry of Health criteria: dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue fever with complications (DWC). DHF and DWC were considered severe dengue, and DF was classified as non-severe dengue. A logistic regression analysis was performed with severe dengue as the outcome. During the study period, 1,229 cases of severe dengue were reported; of these, 812 in patients under the age of 15 (66%). Among the risk factors evaluated, age under 15 years old (OR = 3.10, 95% CI = 2.69-3.57, p-value = 0.001) was associated with severe dengue. The prevalence of severe dengue in children under the age of 15 was higher, and only this age group was associated with the occurrence of severe dengue.
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Affiliation(s)
- José de Jesus Dias
- Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde
Coletiva, São Luís, Maranhão, Brazil
| | - Maria dos Remédios Freitas Carvalho Branco
- Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde
Coletiva, São Luís, Maranhão, Brazil
- Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde e
Ambiente, São Luís, Maranhão, Brazil
| | | | - Alcione Miranda dos Santos
- Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde
Coletiva, São Luís, Maranhão, Brazil
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Epidemiological assessment of the severity of dengue epidemics in French Guiana. PLoS One 2017; 12:e0172267. [PMID: 28196111 PMCID: PMC5308833 DOI: 10.1371/journal.pone.0172267] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 02/02/2017] [Indexed: 11/19/2022] Open
Abstract
Background Dengue fever is the most important arboviral infection that affects humans, particularly in tropical and subtropical regions. Here, we provide the first comprehensive overview of the severity of dengue epidemics in French Guiana. Methodology/Principal findings We monitored hospitalized cases between 2008 and 2013. Detailed clinical features and biological parameters were collected on a daily basis from all cases. Among the 1,356 cases, 216 (16%) were classified according to the WHO 2009 classification as dengue without warning signs (WS), 926 (68%) were classified as dengue with WS and 214 (16%) were classified as severe dengue. The severity rates were similar between the three major epidemics that occurred during the study period, whereas the hospitalization rate was highest in 2013. Fluid accumulation, aspartate aminotransferase (ASAT) counts>193 IU/L and platelet counts<75,000 cells/mm3 were associated with dengue severity. Conclusions/Significance Our findings provide a recent epidemiological description of the severity of dengue epidemics in French Guiana. These results highlight the potential impacts and consequences of implementing the WHO 2009 classification on hospital activity. Future studies should include virological and immunological investigations of well-documented serum samples.
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Abstract
Dengue is widespread throughout the tropics and local spatial variation in dengue virus transmission is strongly influenced by rainfall, temperature, urbanization and distribution of the principal mosquito vector Aedes aegypti. Currently, endemic dengue virus transmission is reported in the Eastern Mediterranean, American, South-East Asian, Western Pacific and African regions, whereas sporadic local transmission has been reported in Europe and the United States as the result of virus introduction to areas where Ae. aegypti and Aedes albopictus, a secondary vector, occur. The global burden of the disease is not well known, but its epidemiological patterns are alarming for both human health and the global economy. Dengue has been identified as a disease of the future owing to trends toward increased urbanization, scarce water supplies and, possibly, environmental change. According to the WHO, dengue control is technically feasible with coordinated international technical and financial support for national programmes. This Primer provides a general overview on dengue, covering epidemiology, control, disease mechanisms, diagnosis, treatment and research priorities.
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Affiliation(s)
- Maria G Guzman
- Institute of Tropical Medicine 'Pedro Kouri', PAHO/WHO Collaborating Center for the Study of Dengue and its Vector, Autopista Novia del Mediodia, Km 6 1/2, Havana 11400, Cuba
| | - Duane J Gubler
- Program in Emerging Infectious Diseases, Duke-NUS Graduate Medical School, Singapore
| | - Alienys Izquierdo
- Institute of Tropical Medicine 'Pedro Kouri', PAHO/WHO Collaborating Center for the Study of Dengue and its Vector, Autopista Novia del Mediodia, Km 6 1/2, Havana 11400, Cuba
| | - Eric Martinez
- Institute of Tropical Medicine 'Pedro Kouri', PAHO/WHO Collaborating Center for the Study of Dengue and its Vector, Autopista Novia del Mediodia, Km 6 1/2, Havana 11400, Cuba
| | - Scott B Halstead
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Burattini MN, Lopez LF, Coutinho FA, Siqueira JB, Homsani S, Sarti E, Massad E. Age and regional differences in clinical presentation and risk of hospitalization for dengue in Brazil, 2000-2014. Clinics (Sao Paulo) 2016; 71:455-63. [PMID: 27626476 PMCID: PMC4975787 DOI: 10.6061/clinics/2016(08)08] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 04/29/2016] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Dengue cases range from asymptomatic to severe, eventually leading to hospitalization and death. Timely and appropriate management is critical to reduce morbidity. Since 1980, dengue has spread throughout Brazil, affecting an increasing number of individuals. This paper describes age and regional differences in dengue's clinical presentation and associated risk of hospitalization based on more than 5 million cases reported to the Brazilian Ministry of Health from 2000-2014. METHODS We performed a retrospective analysis of ∼5,450,000 dengue cases, relating clinical manifestations and the risk of hospitalization to age, gender, previous infection by dengue, dengue virus serotype, years of formal education, delay to first attendance and the occurrence of dengue during outbreaks and in different Brazilian regions. RESULTS Complicated forms of dengue occurred more frequently among those younger than 10 years (3.12% vs 1.92%) and those with dengue virus 2 infection (7.65% vs 2.42%), with a delay to first attendance >2 days (3.18% vs 0.82%) and with ≤4 years of formal education (2.02% vs 1.46%). The risk of hospitalization was higher among those aged 6-10 years old (OR 4.57; 95% CI 1.43-29.96) and those who were infected by dengue virus 2 (OR 6.36; 95% CI 2.52-16.06), who lived in the Northeast region (OR 1.38; 95% CI 1.11-2.10) and who delayed first attendance by >5 days (composite OR 3.15; 95% CI 1.33-8.9). CONCLUSIONS In Brazil, the occurrence of severe dengue and related hospitalization is associated with being younger than 10 years old, being infected by dengue virus 2 or 3, living in the Northeast region (the poorest and the second most populated) and delaying first attendance for more than 2 days.
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Affiliation(s)
- Marcelo N. Burattini
- Faculdade de Medicina da Universidade de São Paulo, Divisão de Informática Médica, São Paulo/SP, Brazil
- Hospital São Paulo, Escola Paulista de Medicina, São Paulo/SP, Brazil
- E-mail: //
| | - Luis F. Lopez
- Faculdade de Medicina da Universidade de São Paulo, Divisão de Informática Médica, São Paulo/SP, Brazil
- CIARA, Florida International University, Miami, Florida, United States of America
| | - Francisco A.B. Coutinho
- Faculdade de Medicina da Universidade de São Paulo, Divisão de Informática Médica, São Paulo/SP, Brazil
| | - João B. Siqueira
- Universidade Federal de Goiás, Instituto Tropical de Patologia e Saúde Pública, Goiânia/GO, Brazil
| | | | - Elsa Sarti
- Sanofi Pasteur Latinoamerica, Mexico City, Mexico
| | - Eduardo Massad
- Faculdade de Medicina da Universidade de São Paulo, Divisão de Informática Médica, São Paulo/SP, Brazil
- London School of Hygiene and Tropical Medicine, London, UK
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Cavalcanti LPDG, Braga DNDM, Pompeu MMDL, Lima AAB, Silva LMAD, Aguiar MG, Castiglioni M, Araújo FMDC, Malta DL, Queiroz A. Evaluation of the World Health Organization 2009 classification of dengue severity in autopsied individuals, during the epidemics of 2011 and 2012 in Brazil. Rev Soc Bras Med Trop 2016; 48:658-64. [PMID: 26676489 DOI: 10.1590/0037-8682-0287-2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/11/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The dengue classification proposed by the World Health Organization (WHO) in 2009 is considered more sensitive than the classification proposed by the WHO in 1997. However, no study has assessed the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue. In the present study, we evaluated the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue in Northeast Brazil, where the disease is endemic. METHODS This retrospective study included 121 autopsied individuals suspected of having dengue in Northeast Brazil during the epidemics of 2011 and 2012. All the autopsied individuals included in this study were confirmed to have dengue based on the findings of laboratory examinations. RESULTS The median age of the autopsied individuals was 34 years (range, 1 month to 93 years), and 54.5% of the individuals were males. According to the WHO 1997 classification, 9.1% (11/121) of the cases were classified as dengue hemorrhagic fever (DHF) and 3.3% (4/121) as dengue shock syndrome. The remaining 87.6% (106/121) of the cases were classified as dengue with complications. According to the 2009 classification, 100% (121/121) of the cases were classified as severe dengue. The absence of plasma leakage (58.5%) and platelet counts <100,000/mm3 (47.2%) were the most frequent reasons for the inability to classify cases as DHF. CONCLUSIONS The WHO 2009 classification is more sensitive than the WHO 1997 classification for identifying dengue deaths among autopsied individuals suspected of having dengue.
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Affiliation(s)
| | | | | | | | | | | | - Mariana Castiglioni
- Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Ceará, Brazil
| | | | | | - Anastácio Queiroz
- Departamento de Patologia, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
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Horstick O, Martinez E, Guzman MG, Martin JLS, Ranzinger SR. WHO dengue case classification 2009 and its usefulness in practice: an expert consensus in the Americas. Pathog Glob Health 2015; 109:19-25. [PMID: 25630344 DOI: 10.1179/2047773215y.0000000003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION In 2009, the new World Health Organization (WHO) dengue case classification - dengue/severe dengue (D/SD) - was introduced, replacing the 1997 WHO dengue case classification: dengue fever/dengue haemorrhagic fever/dengue shock syndrome (DF/DHF/DSS). METHODS A 2-day expert consensus meeting in La Habana/Cuba aimed to (1) share the experiences from Pan American Health Organization (PAHO) member states when applying D/SD, (2) present national and local data using D/SD, and (3) agree with the presented evidence on a list of recommendations for or against the use of D/SD for PAHO, and also globally. RESULTS Eight key questions were discussed, concluding: (1) D/SD is useful describing disease progression because it considers the dynamic nature of the disease, (2) D/SD helps defining dengue cases correctly for clinical studies, because it defines more precisely disease severity and allows evaluating dynamically the progression of cases, (3) D/SD describes correctly all clinical forms of severe dengue. Further standards need to be developed regionally, especially related to severe organ involvement, (4) D/SD allows for pathophysiological research identifying - in a sequential manner - the clinical manifestations of dengue related to pathophysiological events, (5) the warning signs help identifying early cases at risk of shock (children and adults), pathophysiology of the warning signs deserves further studies, (6) D/SD helps treating individual dengue cases and also the reorganization of health-care services for outbreak management, (7) D/SD helps diagnosing dengue, in presumptive diagnosis and follow-up of the disease, because of its high sensitivity and high negative predictive value (NPV), and (8) there is currently no update of the International Disease Classification10 (ICD10) to include the new classification of dengue (D/SD); therefore, there are not enough experiences of epidemiological reporting. Once D/SD has been implemented in epidemiological surveillance, D/SD allows to (1) identify severity of dengue cases in real time, for any decision-making on actions, (2) measure and compare morbidity and mortality in countries, and also globally, and (3) trigger contingency plans early, not only based on the number of reported cases but also on the reported severity of cases. CONCLUSION The expert panel recommends to (1) update ICD10, (2) include D/SD in country epidemiological reports, and (3) implement studies improving sensitivity/specificity of the dengue case definition.
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Sacramento RHM, de Melo Braga DN, Sacramento FF, de Carvalho Araújo FM, Lima AAB, de Lima Pompeu MM, Lima DM, de Góes Cavalcanti LP. Death by dengue fever in a Brazilian child: a case report. BMC Res Notes 2014; 7:855. [PMID: 25428248 PMCID: PMC4255653 DOI: 10.1186/1756-0500-7-855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/11/2014] [Indexed: 11/18/2022] Open
Abstract
Background Dengue is an important worldwide public health problem, and continues to spread in Brazil. This article presents the first Brazilian case report of the death of an indigenous child by dengue fever. Case presentation In August 2013, a child aged 2 years and from the Tremembé ethnic group, who was previously healthy with no complaints, suddenly presented intense crying, precordial pain, and general malaise. A few minutes after these non-specific symptoms, the patient started tonic–clonic convulsions and had cyanosis, a substantial increase in body temperature to the touch, cold sudoresis, sphincter relaxation, and unconsciousness. This situation remained for 15 minutes, progressing to respiratory insufficiency, with consequent absence of peripheral pulses. Death was confirmed approximately 40 minutes after the first symptoms. An autopsy was performed using the usual techniques. Immunohistochemistry was positive for dengue, and microscopic examination indicated micro perivascular edema and cerebral hemorrhage. Conclusion Considering that the death occurred during the major endemic seasonal period for dengue fever, primary clinical evidence suggestive of viral infection presenting with sudden and quick death, and positive immunohistochemistry results, the case was closed as severe dengue fever. Clinicians must consider dengue as a diagnostic hypothesis among the indigenous population in Brazil.
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Affiliation(s)
| | | | | | | | | | | | | | - Luciano Pamplona de Góes Cavalcanti
- Department of Community Health, School of Medicine, Federal University of Ceará, St, Prof, Costa Mendes 1608, 5th Floor, Fortaleza, CE 60430-140, Brazil.
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Vieira Machado AA, Estevan AO, Sales A, Brabes KCDS, Croda J, Negrão FJ. Direct costs of dengue hospitalization in Brazil: public and private health care systems and use of WHO guidelines. PLoS Negl Trop Dis 2014; 8:e3104. [PMID: 25188295 PMCID: PMC4154670 DOI: 10.1371/journal.pntd.0003104] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 07/08/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Dengue, an arboviral disease, is a public health problem in tropical and subtropical regions worldwide. In Brazil, epidemics have become increasingly important, with increases in the number of hospitalizations and the costs associated with the disease. This study aimed to describe the direct costs of hospitalized dengue cases, the financial impact of admissions and the use of blood products where current protocols for disease management were not followed. METHODS AND RESULTS To analyze the direct costs of dengue illness and platelet transfusion in Brazil based on the World Health Organization (WHO) guidelines, we conducted a retrospective cross-sectional census study on hospitalized dengue patients in the public and private Brazilian health systems in Dourados City, Mato Grosso do Sul State, Brazil. The analysis involved cases that occurred from January through December during the 2010 outbreak. In total, we examined 8,226 mandatorily reported suspected dengue cases involving 507 hospitalized patients. The final sample comprised 288 laboratory-confirmed dengue patients, who accounted for 56.8% of all hospitalized cases. The overall cost of the hospitalized dengue cases was US $210,084.30, in 2010, which corresponded to 2.5% of the gross domestic product per capita in Dourados that year. In 35.2% of cases, blood products were used in patients who did not meet the blood transfusion criteria. The overall median hospitalization cost was higher (p = 0.002) in the group that received blood products (US $1,622.40) compared with the group that did not receive blood products (US $550.20). CONCLUSION The comparative costs between the public and the private health systems show that both the hospitalization of and platelet transfusion in patients who do not meet the WHO and Brazilian dengue guidelines increase the direct costs, but not the quality, of health care.
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Affiliation(s)
| | - Anderson Oliveira Estevan
- Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
| | - Antonio Sales
- Faculty of Math, State University of Mato Grosso do Sul, Nova Andradina, Mato Grosso do Sul, Brazil
| | | | - Júlio Croda
- Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
| | - Fábio Juliano Negrão
- Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
- * E-mail:
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Predictive symptoms and signs of severe dengue disease for patients with dengue fever: a meta-analysis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:359308. [PMID: 25097856 PMCID: PMC4100454 DOI: 10.1155/2014/359308] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/03/2014] [Accepted: 06/11/2014] [Indexed: 12/20/2022]
Abstract
The aim of the meta-analysis was to provide more solid evidence for the reliability of the new classification. A systematic literature search was performed using PubMed, Armed Forces Pest Management Board Literature Retrieval System, and Google Scholar up to August 2012. A pooled odds ratio (OR) was calculated using either a random-effect or a fixed-effect model. A total of 16 papers were identified. Among the 11 factors studied, five symptoms demonstrated an increased risk for SDD, including bleeding [OR: 13.617; 95% confidence interval (CI): 3.281, 56.508], vomiting/nausea (OR: 1.692; 95% CI: 1.256, 2.280), abdominal pain (OR: 2.278; 95% CI: 1.631, 3.182), skin rashes (OR: 2.031; 95% CI: 1.269, 3.250), and hepatomegaly (OR: 4.751; 95% CI: 1.769, 12.570). Among the four bleeding-related symptoms including hematemesis, melena, gum bleeding, and epistaxis, only hematemesis (OR: 6.174; 95% CI: 2.66, 14.334; P < 0.001) and melena (OR: 10.351; 95% CI: 3.065, 34.956; P < 0.001) were significantly associated with SDD. No significant associations with SDD were found for gender, lethargy, retroorbital pain, diarrhea, or tourniquet test, whereas headache appeared protective (OR: 0.555; 95% CI: 0.455, 0.676). The meta-analysis suggests that bleeding (hematemesis/melena), vomiting/nausea, abdominal pain, skin rashes, and hepatomegaly may predict the development of SDD in patients with DF, while headache may predict otherwise.
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Nujum ZT, Thomas A, Vijayakumar K, Nair RR, Pillai MR, Indu PS, Sundar S, Gopakumar S, Mohan D, Sudheeshkumar TK. Comparative performance of the probable case definitions of dengue by WHO (2009) and the WHO-SEAR expert group (2011). Pathog Glob Health 2014; 108:103-10. [PMID: 24606537 DOI: 10.1179/2047773214y.0000000131] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The primary objective of this study was to find the performance of the 2009 probable case definition of dengue and compare it with the definition given by the WHO-SEAR expert group in 2011. METHODS A cross-sectional study was conducted in Thiruvananthapuram district of Kerala, which is hyperendemic for dengue. A consecutive series of 851 participants defined by the selection criteria were recruited from the primary, secondary, and tertiary health care settings. Sensitivity, specificity, predictive values, and likelihood ratios of the clinical case definitions were calculated using reverse transcriptase-polymerized chain reaction (RT-PCR) as gold standard in case of fever less than or equal to 5 days and serology (IgM positivity) for fever >5 days. Diagnostic odds ratio (DOR) was also calculated as a single indicator of performance of the case definition. RESULTS The 2009 World Health Organization (WHO) case definition had a sensitivity of 76·4% (69·6-82·1) and negative predictive value of 87·5%. The 2011 WHO-SEAR expert group case definition had a higher sensitivity of 87·9% (82·2-91·9) but lower negative predictive value of 86·6%. The three independent criteria which were significantly associated with dengue were thrombocytopenia less than 150,000 (OR 2·80), leukopenia (OR 2·28), and absence of backache (OR 2·68). The performance of 2009 case definition was better (DOR 2·4) than the 2011 WHO-SEAR expert group case definition. This was further enhanced when thrombocytopenia was specified as platelet count less than 150,000 (DOR2·7). When 'no backahe' was added as an additional criteria, the performance of both definitions improved. CONCLUSIONS The 2009 WHO case definition has better discriminatory power than the 2011 WHO-SEAR expert group case definition. The performance of 2009 WHO case definition is enhanced by specifying thrombocytopenia as platelet count less than 150,000. The inclusion of 'no backache' further improves the discriminatory power. This may be more useful in primary care settings, to rule out dengue.
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