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Atella MO, Carvalho AS, Da Poian AT. Role of macrophages in the onset, maintenance, or control of arthritis caused by alphaviruses. Exp Biol Med (Maywood) 2023; 248:2039-2044. [PMID: 38058027 PMCID: PMC10800133 DOI: 10.1177/15353702231214261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Arthritogenic alphaviruses are mosquito-borne viruses that cause a debilitating rheumatic disease characterized by fever, headache, rash, myalgia, and polyarthralgia with the potential to evolve into a severe and very prolonged illness. Although these viruses have been geographically restricted by vector hosts and reservoirs, recent epidemics have revealed the risks of their spread worldwide. In this review, we aim to discuss the protective and pathological roles of macrophages during the development of arthritis caused by alphaviruses. The progression to the chronic phase of the disease is related to the extension of viral replication and the maintenance of articular inflammation, in which the cellular infiltrate is predominantly composed of macrophages. We explore the possible implications of macrophage polarization to M1/M2 activation phenotypes, drawing a parallel between alphavirus arthritis and rheumatoid arthritis (RA), a chronic inflammatory disease that also affects articular tissues. In RA, it is well established that M1 macrophages contribute to tissue damage and inflammation, while M2 macrophages have a role in cartilage repair, so modulating the M1/M2 macrophage ratio is being considered as a strategy in the treatment of this disease. In the case of alphavirus-induced arthritis, the picture is more complex, as proinflammatory factors derived from M1 macrophages contribute to the antiviral response but cause tissue damage, while M2 macrophages may contribute to tissue repair but impair viral clearance.
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Affiliation(s)
| | | | - Andrea T Da Poian
- Instituto de Bioquímica Médica Leopoldo de Meis, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ 21941-902, Brazil
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2
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Hwee TANGP, Koh Cheng THOON. Imaging of Congenital/Childhood Central Nervous System Infections. Neuroimaging Clin N Am 2023; 33:207-224. [DOI: 10.1016/j.nic.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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3
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Yang CWR, Mason M, Parizel PM, Warne R. Magnetic resonance imaging patterns of paediatric brain infections: a pictorial review based on the Western Australian experience. Insights Imaging 2022; 13:160. [PMID: 36194350 PMCID: PMC9532482 DOI: 10.1186/s13244-022-01298-1] [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: 05/30/2022] [Accepted: 09/10/2022] [Indexed: 12/01/2022] Open
Abstract
Paediatric brain infections are relatively uncommon, but it is important for radiologists to recognise the disease and provide accurate differential diagnoses. Magnetic resonance imaging (MRI) plays an important role in determining the most likely causative pathogen—either in the setting of an unwell child with acute infectious encephalitis, or in the evaluation of a child for sequela of prior infection. Image analysis can, however, be difficult since a particular pathogen can cause variable MRI findings across different geographic environments, and conversely, a particular appearance on MRI may be caused by a variety of pathogens. This educational review aims to identify some of the key MRI patterns seen in paediatric brain infections and present example cases encountered in Western Australia. Based on (i) the predominant type of signal abnormality (restricted diffusion versus T2 hyperintensity) and (ii) the distribution of signal abnormality throughout the brain, this review presents a framework of six key MRI patterns seen in paediatric brain infections, with an emphasis on acute infectious encephalitis. There is general utility to these MRI patterns—each suggestive of a group of likely diagnostic possibilities which can be calibrated according to institution and local environment. The pattern-based framework of this review can be easily transitioned into daily radiological practice, and we hope it facilitates the formation of accurate differential diagnoses in paediatric brain infections.
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Affiliation(s)
- Chi-Wei Robin Yang
- Department of Medical Imaging, Perth Children's Hospital (PCH), 15 Hospital Avenue, Nedlands, WA, 6009, Australia.
| | - Michael Mason
- Department of Medical Imaging, Perth Children's Hospital (PCH), 15 Hospital Avenue, Nedlands, WA, 6009, Australia
| | - Paul M Parizel
- Department of Radiology, University of Western Australia (UWA), Royal Perth Hospital (RPH), Perth, WA, Australia
| | - Richard Warne
- Department of Medical Imaging, Perth Children's Hospital (PCH), 15 Hospital Avenue, Nedlands, WA, 6009, Australia
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Faustino R, Carvalho FR, Medeiros T, Familiar-Macedo D, Vianna RADO, Leite PEC, Pereira IR, Cardoso CAA, De Azeredo EL, Silva AA. Pro-Inflammatory Profile of Children Exposed to Maternal Chikungunya Virus Infection during the Intrauterine Period: A One-Year Follow-Up Study. Viruses 2022; 14:v14091881. [PMID: 36146688 PMCID: PMC9501274 DOI: 10.3390/v14091881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Chikungunya virus (CHIKV) vertical transmission occurs due to maternal viremia in the prepartum. Clinical presentation in neonates can be varied; however, the consequences of intrauterine exposure on the immune response are unclear. Thus, we aimed to analyze inflammatory alterations in children exposed to maternal CHIKV infection. This is a cross-sectional study that included children exposed to maternal CHIKV infection (confirmed by RT-qPCR and/or IgM). Circulant immune mediators were analyzed by a multiplex assay. RESULTS: We included 33 children, with a mean age of 3 ± 2.9 months-old, and 19 (57.6%) were male. Only one child presented neurological alterations. CHIKV-exposed infants showed elevated levels of MIP-1α, MIP-1β, and CCL-2 (p < 0.05). Pro-inflammatory cytokines such as TNFα, IL-6, and IL-7 (p < 0.0001) were also increased. In addition, lower levels of PDGF-BB and GM-CSF were observed in the same group (p < 0.0001). Principal component (PC) analysis highlighted a distinction in the inflammatory profile between groups, where PC explained 56.6% of the alterations. Our findings suggest that maternal exposure to CHIKV can affect the circulating levels of pro-inflammatory cytokines during the infants’ first year of life. The long-term clinical consequences of these findings should be investigated.
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Affiliation(s)
- Renan Faustino
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi 24033-900, Brazil
| | - Fabiana Rabe Carvalho
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi 24033-900, Brazil
| | - Thalia Medeiros
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi 24033-900, Brazil
- Department of Pathology, Faculty of Medicine, Universidade Federal Fluminense, Niterói 24033-900, Brazil
| | - Débora Familiar-Macedo
- Viral Immunology Laboratory, Oswaldo Cruz Institute, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, Brazil
| | - Renata Artimos de Oliveira Vianna
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi 24033-900, Brazil
| | | | - Isabela Resende Pereira
- Department of Pathology, Faculty of Medicine, Universidade Federal Fluminense, Niterói 24033-900, Brazil
| | - Claudete Aparecida Araújo Cardoso
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi 24033-900, Brazil
- Department of Maternal and Child, Faculty of Medicine, Universidade Federal Fluminense, Niterói 24033-900, Brazil
| | - Elzinandes Leal De Azeredo
- Viral Immunology Laboratory, Oswaldo Cruz Institute, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, Brazil
- Correspondence: (E.L.D.A.); (A.A.S.); Tel.: +55-(21)-3674-7285 (A.A.S.)
| | - Andrea Alice Silva
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi 24033-900, Brazil
- Department of Pathology, Faculty of Medicine, Universidade Federal Fluminense, Niterói 24033-900, Brazil
- Correspondence: (E.L.D.A.); (A.A.S.); Tel.: +55-(21)-3674-7285 (A.A.S.)
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Corrêa DG, Freddi TDAL, Chaves CG, Hygino da Cruz LC. Neuroimaging features of arboviral infections in the Americas. Clin Imaging 2022; 85:64-73. [PMID: 35247791 DOI: 10.1016/j.clinimag.2022.02.028] [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: 11/25/2021] [Accepted: 02/25/2022] [Indexed: 11/03/2022]
Abstract
Arboviruses are zoonotic RNA viruses maintained in nature in cycles that involve arthropod vectors. The arboviruses that cause disease in humans are members of the Bunyaviridae, Togaviridae, Flaviviridae, and Reoviridae families. These viral species have geographically and climatically restricted distributions due to particular ecological and vector features. The main emerging arboviruses in the Americas are dengue, zika, yellow fever (Flaviviridae), and chikungunya (Togaviridae). All of these viruses can be transmitted by the Aedes aegypti and Aedes albopictus mosquitoes. Although not commonly, these infections are associated with neurological complications, characterized mainly by hemorrhage, encephalitis, myelitis, acute disseminated encephalomyelitis, Guillain-Barré syndrome, and/or congenital malformations. This review describes the imaging features of the neurological complications of these emerging arbovirus infections.
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Affiliation(s)
- Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ 2640-102, Brazil; Department of Radiology, Federal Fluminense University, Rua Marquês de Paraná, 303, Centro, Niterói, RJ 24070-035, Brazil.
| | | | - Cínthia Guedes Chaves
- Department of Radiology, Hospital das Américas, United Health Group, Avenida Jorge Curi, 550, Barra da Tijuca, Rio de Janeiro, RJ 22775-001, Brazil
| | - Luiz Celso Hygino da Cruz
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ 2640-102, Brazil
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Rueda-Lopes FC, da Cruz LCH, Fontes FL, Herlinger AL, da Costa Ferreira Junior O, de Aguiar RS, Vasconcelos CCF, do Nascimento OJM, Alves-Leon SV. Clinical and magnetic resonance imaging patterns of extensive Chikungunya virus-associated myelitis. J Neurovirol 2021; 27:616-625. [PMID: 34227044 DOI: 10.1007/s13365-021-00962-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 02/03/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
Chikungunya fever is an arbovirus infection transmitted by the same mosquito vector of dengue and Zika virus. Besides high fever, common clinical symptoms include articular pain and general malaise. Neurological involvement is unusual, but some patients may develop peripheral and central nervous system involvement, including meningoencephalitis, myelitis, Guillain-Barré syndrome, and acute disseminated encephalomyelitis. We present three cases of Chikungunya fever complicated with extensive myelitis. The spinal cord magnetic resonance imaging (MRI) pattern is characterized by multiple dotted-like and longitudinal hyperintense lesions, with contrast enhancement, mostly distributed in the peripheral regions of the spinal cord. It seems that these lesions are mostly located in the perivascular spaces (PVS), related or not to virus attack. Involvement of brain PVS can also be demonstrated, as shown in two of the cases described. Considering the MRI pattern, extensive spinal cord lesion should include Chikungunya as a differential diagnosis, especially during an outbreak.
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Affiliation(s)
- Fernanda Cristina Rueda-Lopes
- Radiology Department of Fluminense Federal University (UFF), DASA (Diagnósticos da América), Avenida Roberto Silveira, 349/1904, Icaraí, Niteroi, Brazil.
| | | | - Fabrícia Lima Fontes
- Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Alice Laschuk Herlinger
- Genetics Department, Biology Institute, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Renato Santana de Aguiar
- Genetics Department, Biology Institute, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Neurology Department, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Claudia Cristina Ferreira Vasconcelos
- Neurology Department of Fluminense Federal University (UFF), Rio de Janeiro, Brazil.,Neurology Department of Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Osvaldo José Moreira do Nascimento
- Neurology Department of Fluminense Federal University (UFF), Rio de Janeiro, Brazil.,Neurology Department of Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Soniza Vieira Alves-Leon
- Genetics Department, Biology Institute, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Vertical transmission of chikungunya virus: A systematic review. PLoS One 2021; 16:e0249166. [PMID: 33891622 PMCID: PMC8064608 DOI: 10.1371/journal.pone.0249166] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/13/2021] [Indexed: 01/23/2023] Open
Abstract
Objectives To describe and estimate the frequency of pregnancy outcomes, clinical and laboratory characteristics of vertical transmission of CHIKV in the neonate. Study design We performed a systematic review evaluating the clinical presentation of perinatally-acquired CHIKV infection in neonates. The search was performed using Medline (via PubMed), LILACS, Web of Science, Scielo, Google Scholar and Open grey to identify studies assessing vertical transmission of CHIKV up to November 3, 2020. There were no search restrictions regarding the study type, the publication date or language. Studies with no documented evidence of CHIKV infection in neonates (negative RT-PCR or absence of IgM) were excluded. Results From the 227 studies initially identified, 42 were selected as follows: 28 case reports, 7 case series, 2 cross-sectional studies and 5 cohort studies, for a total of 266 CHIKV infected neonates confirmed by serological and/or molecular tests. The vertical transmission rate was 50% in the Reunion Island outbreak, which was the subject of the majority of the studies; the premature delivery were reported in 19 (45.2%) studies; the rate of fetal distress was 19.6% of infected babies and fetal loss occurred in 2% of the cases. Approximately 68.7% of newborns were diagnosed with encephalopathy or encephalitis after perinatally acquired CHIKV. Most of the infected neonates were born healthy, developing CHIKV sepsis clinical syndrome within the first week of life. Conclusions We alert neonatologists to the late manifestations of neonatal CHIKV infection, relevant to the management and reduction of morbidity. A limitation of our review was that it was not possible to carry out meta-analysis due to differences in study design and the small number of participants.
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Corrêa DG, Di Maio Ferreira FCPDA, Hygino da Cruz LC, Brasil P, Rueda Lopes FC. Longitudinal brain magnetic resonance imaging of children with perinatal Chikungunya encephalitis. Neuroradiol J 2020; 33:532-537. [PMID: 32955404 DOI: 10.1177/1971400920959070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Chikungunya virus can be transmitted perinatally leading to serious neurological sequelae. We report the longitudinal evolution of the brain magnetic resonance imaging aspects of three cases of mother-to-child Chikungunya virus transmission. The first magnetic resonance imaging scan presented brain cavitations, with or without corpus callosum diffusion restriction. Follow-up scans showed reduction in the volume of cavitations, with resolution of the restricted diffusion. However, one patient presented with a normal brain magnetic resonance image, despite the delay in neurocognitive development.
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Affiliation(s)
- Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Brazil.,Department of Radiology, Hospital Universitário Antônio Pedro, Brazil
| | | | | | - Patrícia Brasil
- Department of Infectious Diseases, Fundação Oswaldo Cruz, Brazil
| | - Fernanda Cristina Rueda Lopes
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Brazil.,Department of Radiology, Hospital Universitário Antônio Pedro, Brazil
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