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van de Weg CAM, Thomazella MV, Marmorato MP, Correia CA, Dias JZC, Maestri A, Zanella LGFABE, Cerqueira NB, Félix AC, Moreira CHV, Buccheri R, Costa PR, Kallás EG. Levels of angiopoietin-2 are predictive for mortality in yellow fever virus infected patients. J Infect Dis 2023:jiad389. [PMID: 37711029 DOI: 10.1093/infdis/jiad389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/25/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023] Open
Abstract
In 2018 there was a large yellow fever outbreak in São Paulo, Brazil, with a high fatality rate. Yellow fever virus can cause, among other symptoms, haemorrhage and disseminated intravascular coagulation, indicating a role for endothelial cells in the disease pathogenesis. Here, we conducted a case-control study and measured markers related to endothelial damage in plasma and its association with mortality. We found that angiopoietin-2 is strongly associated with a fatal outcome and could serve as a predictive marker for mortality. This could be used to monitor severe patients and provide care to improve disease outcome.
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Affiliation(s)
- Cornelia A M van de Weg
- Medical Investigation Laboratory 60 (LIM-60), School of Medicine, University of São Paulo, São Paulo, SP, Brazil
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mateus V Thomazella
- Medical Investigation Laboratory 60 (LIM-60), School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Mariana P Marmorato
- Medical Investigation Laboratory 60 (LIM-60), School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Carolina A Correia
- Medical Investigation Laboratory 60 (LIM-60), School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Juliana Z C Dias
- Medical Investigation Laboratory 60 (LIM-60), School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Alvino Maestri
- Medical Investigation Laboratory 60 (LIM-60), School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Luiz G F A B E Zanella
- Medical Investigation Laboratory 60 (LIM-60), School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Natalia B Cerqueira
- Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Alvina C Félix
- Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Carlos H V Moreira
- Infectious Diseases Institute "Emílio Ribas", São Paulo, SP, Brazil
- Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
- Division of HIV, ID, & Global Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, USA
| | - Renata Buccheri
- Infectious Diseases Institute "Emílio Ribas", São Paulo, SP, Brazil
| | - Priscilla R Costa
- Medical Investigation Laboratory 60 (LIM-60), School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Esper G Kallás
- Medical Investigation Laboratory 60 (LIM-60), School of Medicine, University of São Paulo, São Paulo, SP, Brazil
- Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Avelino-Silva VI, Thomazella MV, Marmorato MP, Correia CA, Dias JZC, Maestri A, Cerqueira NB, Moreira CHV, Buccheri R, Félix AC, Zanella LGFABE, Costa PR, Kallás EG. Viral Kinetics in Sylvatic Yellow Fever Cases. J Infect Dis 2022; 227:1097-1103. [PMID: 36316804 DOI: 10.1093/infdis/jiac435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/27/2022] Open
Abstract
Abstract
Background
Yellow fever is a mosquito-borne zoonotic disease caused by yellow fever virus (YFV). Between 2017 and 2019, more than 504 human cases and 176 deaths were confirmed in the outskirts of São Paulo city. Throughout this outbreak, studies suggested a potential association between YFV viremia and mortality.
Methods
Viral ribonucleic acid was measured using reverse-transcription quantitative polymerase chain reaction in plasma samples collected at up to 5 time points, between 3 and 120 days after symptoms onset.
Results
Eighty-four patients with confirmed YFV infection were included. Most were males, median age was 42, and 30 (36%) died. Deceased patients were older than survivors (P = .003) and had a higher viremia across all time points (P = .0006). Mean values of viremia had a positive, statistically significant correlation with peak values of neutrophils, indirect bilirubin, aspartate transaminase, international normalized ratio, and creatinine. Finally, a Cox proportional hazards model adjusted for age and laboratory variables showed that viremia is independently associated with death, with a mean 1.84-fold increase (84%) in the hazard of death (P < .001) for each unit increase in mean log10 viremia.
Conclusions
Our results raise the importance of monitoring YFV viremia and suggest a potential benefit of antiviral drugs or neutralizing monoclonal antibodies early in the course of this infection to improve disease outcomes.
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Affiliation(s)
- Vivian I Avelino-Silva
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 05403-000 , Brazil
| | - Mateus Vailant Thomazella
- Medical Investigation Laboratory 60 (LIM-60), Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 1246-903 , Brazil
| | - Mariana Prado Marmorato
- Medical Investigation Laboratory 60 (LIM-60), Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 1246-903 , Brazil
| | - Carolina A Correia
- Medical Investigation Laboratory 60 (LIM-60), Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 1246-903 , Brazil
| | - Juliana Z C Dias
- Medical Investigation Laboratory 60 (LIM-60), Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 1246-903 , Brazil
| | - Alvino Maestri
- Medical Investigation Laboratory 60 (LIM-60), Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 1246-903 , Brazil
| | - Natalia B Cerqueira
- Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo , SP, 05403-000 , Brazil
| | - Carlos H V Moreira
- Institute of Infectology “Emilio Ribas” , São Paulo, SP, 01246-900 , Brazil
- Institute of Tropical Medicine, Universidade de São Paulo , São Paulo, SP, 05403-000 , Brazil
| | - Renata Buccheri
- Institute of Infectology “Emilio Ribas” , São Paulo, SP, 01246-900 , Brazil
| | - Alvina C Félix
- Institute of Tropical Medicine, Universidade de São Paulo , São Paulo, SP, 05403-000 , Brazil
| | - Luiz G F A B E Zanella
- Medical Investigation Laboratory 60 (LIM-60), Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 1246-903 , Brazil
| | - Priscilla R Costa
- Medical Investigation Laboratory 60 (LIM-60), Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 1246-903 , Brazil
| | - Esper G Kallás
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 05403-000 , Brazil
- Medical Investigation Laboratory 60 (LIM-60), Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, 1246-903 , Brazil
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