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Morel Z, Martínez T, Galeano F, Coronel J, Quintero L, Jimenez R, Ayala J, Amarilla S, Lovera D, Martínez de Cuellar C. Cytokine storm in Chikungunya: Can we call it multisystem inflammatory syndrome associated with Chikungunya? Reumatol Clin (Engl Ed) 2024; 20:223-225. [PMID: 38644032 DOI: 10.1016/j.reumae.2024.04.005] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/18/2023] [Accepted: 10/16/2023] [Indexed: 04/23/2024]
Abstract
Paraguay is currently facing a new outbreak of Chikungunya virus. This report summarizes two severe cases of Chikungunya (CHIKV) infection, confirmed by real-time reverse transcription polymerase chain reaction. We present the cases of patients with acute CHIKV infection and multisystem involvement, with fever, rash, abdominal pain, vomiting, myocarditis, and coronary artery anomalies, very similar to the cases described in MIS-C related to SARS-CoV-2 during the COVID-19 Pandemic. Both patients received IVIG and methylprednisolone, with good clinical response. In this setting of cytokine storm in Chikungunya, can we call it "Multisystem inflammatory syndrome associated with Chikungunya"?.
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Affiliation(s)
- Zoilo Morel
- Pediatric Rheumatology, Pediatrics Department, Hospital Central del Instituto de Previsión Social, Universidad Católica de Asunción, Paraguay.
| | - Tamara Martínez
- Pediatric Intensive Care, Pediatrics Department, Hospital Central del Instituto de Previsión Social, Universidad Católica de Asunción, Paraguay
| | - Fernando Galeano
- Pediatric Infectology, Pediatrics Department, Instituto de Medicina Tropical, Ministry of Public Health, Paraguay
| | - Judith Coronel
- Pediatrics, Instituto Privado del Niño, Asunción, Paraguay
| | - Lorena Quintero
- Pediatric Intensive Care, Pediatrics Department, Hospital Central del Instituto de Previsión Social, Universidad Católica de Asunción, Paraguay
| | - Rolando Jimenez
- Pediatric Intensive Care, Pediatrics Department, Hospital Central del Instituto de Previsión Social, Universidad Católica de Asunción, Paraguay
| | - Jorge Ayala
- Pediatric Infectology, Pediatrics Department, Instituto de Medicina Tropical, Ministry of Public Health, Paraguay
| | - Sara Amarilla
- Pediatric Infectology, Pediatrics Department, Instituto de Medicina Tropical, Ministry of Public Health, Paraguay
| | - Dolores Lovera
- Pediatric Infectology, Pediatrics Department, Instituto de Medicina Tropical, Ministry of Public Health, Paraguay
| | - Celia Martínez de Cuellar
- Pediatric Infectology, Pediatrics Department, Instituto de Medicina Tropical, Ministry of Public Health, Paraguay
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Martínez de Cuellar C, Lovera D, Gianninoto E, Galeano F, Amarilla S, Merlo O. Impacto socio – económico de casos de dengue con signos de alarma y severo, neumonía y meningitis bacteriana aguda, en pacientes pediátricos hospitalizados en un centro de referencia. Pediatr (Asunción) 2022. [DOI: 10.31698/ped.49032022006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introducción: El dengue, la neumonía y la Meningitis Bacteriana Aguda (MBA), producen un elevado impacto socioeconómico, una elevada carga económica y social en los sistemas de salud y la sociedad.
Objetivo: comparar el costo económico y la carga por dengue, neumonía y MBA en ≤15 años hospitalizados, entre enero/07 y mayo/19.
Materiales y Métodos: Estudio observacional, descriptivo. Los datos fueron obtenidos de expedientes de pacientes hospitalizados con diagnósticos de Dengue, neumonía y MBA. Los costos médicos directos se obtuvieron de la base de datos del IMT. Para los costos directos no médicos y los indirectos se utilizó literatura internacional estimados para Paraguay. Los DALYs fueron calculados a partir de la suma de los AVPP y los DVSP.
Resultados: Se identificaron 784, 1419 y 125 pacientes con Dengue, neumonía y MBA, respectivamente. La edad media fue de 118,1±53,6; 34,0±38,9 y 52,1±64,3 meses, respectivamente (p<0.05). La media de días de hospitalización: 4,8±2,8; 9,4±8,7 y 13,8±14,0 días, respectivamente. El 8,9%(70/784) de los casos con dengue, el 29,6%(420/1419) de las neumonías y el 70,4%(88/125) de las MBA requirieron UCI. El 0,6%(5/784), el 5,3%(78/1419) y el 31,2%(39/125) pacientes fallecieron. El costo por hospitalización por dengue, neumonía y meningitis fue de 465496, 3094721 y 127063 US$, respectivamente; los AVPP fueron de 328.1, 5373.4 y 1846.7 años, respectivamente; los DVSP fueron 1459.8, 8595.2 y 996.1, respectivamente y los DALYs de 1641.66; 13968.6 y 2842.8, respectivamente.
Conclusiones: Los costos de atención de estas patologías, inmunoprevenibles, son considerables, producen un impacto social importante, en el sector salud y la economía en general del país.
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González N, Araya S, Amarilla S, Galeano F, Sanabria G, Figueredo J, Arbo A. Randomized, double-blind, placebo-controlled study of doxycycline in patients with dengue. Cytokine modulation and clinical response. Rev Inst Med Trop 2022. [DOI: 10.18004/imt/2022.17.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Lovera D, Amarilla S, Galeano F, Martínez-de Cuellar C, González-Perrotta N, Apodaca S, Aguiar C, Arbo A. Complications associated with severe thrombocytopenia in patients with dengue. Rev Inst Med Trop 2020. [DOI: 10.18004/imt/2020.15.2.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Lovera D, Martínez-Cuellar C, Galeano F, Amarilla S, Vazquez C, Arbo A. Clinical manifestations of primary and secondary dengue in Paraguay and its relation to virus serotype. J Infect Dev Ctries 2019; 13:1127-1134. [PMID: 32088700 DOI: 10.3855/jidc.11584] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 04/19/2019] [Accepted: 08/08/2019] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Dengue virus (DENV) infection is currently a major cause of morbidity in the world, and its incidence has mainly increased during the last years in Latin America, including Paraguay. The objective of this study was to compare the clinical and laboratory findings of dengue and assess whether the serotype is a risk factor for severity. METHODOLOGY We included patients ≤ 15 years old hospitalized with dengue at the Institute of Tropical Medicine, from Paraguay, from 2007 to 2018. Patients were classified according to the 2009 WHO dengue classification guidelines and were stratified by serotype into three groups according to the hospitalization period: the 2007 epidemic (DENV-3), the 2012-2013 epidemic (DENV-2) and the 2016-2018 epidemic (DENV-1). RESULTS Of 784 children hospitalized for dengue, 50 cases (6.3%) were caused by DENV-3, 471 (60%) by DENV-2, and 263 (33.5%) by DENV-1. Myalgias and headache were associated with DENV-3 cases and abdominal pain was associated with DENV-2 cases. Bleeding was observed mainly in DENV-1 and 2 cases. Patients with DENV-2 infections experienced more severe disease, required fluid expansion more frequently, and exhibited more often shock and admission in the ICU. Secondary cases of dengue were more severe that primary cases. Patients with infection by DENV-2 had longer hospital stays (5.1 ± 2.8 days) when compared to DENV-3 o DENV-1 infection cases (2.9 ± 1.6 days and 4.36 ± 2.7 days, respectively) (p < 0.05). CONCLUSIONS The DENV serotype has a profound impact on the clinical manifestations and severity of dengue. DENV-2 infections were associated more frequently to requirement of fluid expansion, shock, and longer hospital stay.
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Affiliation(s)
- Dolores Lovera
- Department of Pediatrics, Institute of Tropical Medicine, Asuncion, Paraguay.
| | | | - Fernando Galeano
- Department of Pediatrics, Institute of Tropical Medicine, Asuncion, Paraguay.
| | - Sara Amarilla
- Department of Pediatrics, Institute of Tropical Medicine, Asuncion, Paraguay.
| | | | - Antonio Arbo
- Department of Pediatrics, Institute of Tropical Medicine, Asuncion, Paraguay.
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Araya S, Galeano F, Amarilla S, González N, Apodaca S, Lovera D, Arbo A. Prognostic factors of severity of invasive community acquired Staphylococcus aureus infections in children. ARCH ARGENT PEDIATR 2019; 117:381-387. [PMID: 31758880 DOI: 10.5546/aap.2019.eng.381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/29/2018] [Accepted: 06/02/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To describe the clinical characteristics of invasive Staphylococcus aureus infections in children and identify the prognostic factors of severity and mortality. MATERIALS AND METHODS Observational study in patients < 16 years old hospitalized between 2010 and 2015 due to invasive S. aureus infections at the Instituto de Medicina Tropical, in Asunción, Paraguay. Patients were distributed based on whether or not they required admission to the intensive care unit, and clinical, laboratory, and evolutionary outcome measures were compared. RESULTS Out of the 107 included patients, 50 (47 %) developed bacteremia; 50 (47 %), pneumonia; and 21 (19 %), multifocal disease. Among the patients who were admitted to the intensive care unit (41 %), prior antibiotic use (p < 0.05), the presence of bacteremia (p = 0.01), the presence of comorbidities (p < 0.05), and multifocal disease (p < 0.01) were more frequent. The overall mortality rate was 15 %. The mortality-associated risk factors were the presence, at the time of admission, of hypotension (p < 0.01), multifocal disease (p < 0.01), bacteremia (p < 0.01), leukopenia (p < 0.01), severe anemia (p < 0.01), and metabolic acidosis (p < 0.01), among others. CONCLUSIONS The prognostic factors of severity included prior antibiotic use, bacteremia, the presence of comorbidities, and presentation with multifocal disease. Mortality was significant; associated risk factors included the presence, at the time of admission, of hypotension, multifocal disease, leukopenia, severe anemia, and metabolic acidosis.
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Affiliation(s)
| | | | | | | | | | | | - Antonio Arbo
- Instituto de Medicina Tropical.,Universidad Nacional de Asunción, Paraguay.
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Gónzalez N, Amarilla S, Zárate C, Lovera D, Apodaca S, Arbo A. IMPACT OF OBESITY IN CHILDREN WITH ACQUIRED PNEUMONIA FROM THE COMMUNITY. Rev Inst Med Trop 2018. [DOI: 10.18004/imt/201813210-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Amarilla S, Lovera D, Martínez- de Cuellar C, Araya S, Aranda C, Chamorro G, Kawabata A, Merlo O, Arbo A. Epidemiology, clinical and prognostic factors of Invasive Meningococcal Disease in a reference center in Paraguay. 2005 to 2018. Rev Inst Med Trop 2018. [DOI: 10.18004/imt/201813140-53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Talarico LB, Byrne AB, Amarilla S, Lovera D, Vázquez C, Chamorro G, Acosta PL, Ferretti A, Caballero MT, Arbo A, Polack FP. Characterization of type I interferon responses in dengue and severe dengue in children in Paraguay. J Clin Virol 2017; 97:10-17. [PMID: 29078078 DOI: 10.1016/j.jcv.2017.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 07/04/2017] [Revised: 10/11/2017] [Accepted: 10/18/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Infection with dengue virus (DENV) produces a wide spectrum of clinical illness ranging from asymptomatic infection to mild febrile illness, and to severe forms of the disease. Type I interferons (IFNs) represent an initial and essential host defense response against viruses. DENV has been reported to trigger a robust type I IFN response; however, IFN-α/β profile in the progression of disease is not well characterized. OBJECTIVES AND STUDY DESIGN In this context, we conducted a retrospective study assessing the circulating serum levels of type I IFNs and related cytokines at different phases of illness in children during the 2011 outbreak of DENV in Paraguay. Demographic, clinical, laboratory and virological data were analyzed. RESULTS During defervescence, significantly higher levels of IFN-β, IL-6 and MIP-1β, were detected in severe vs. non-severe dengue patients. Additionally, a significant positive correlation between INF-α and viremia was detected in children with severe dengue. A significant positive correlation was also observed between IFN-β serum levels and hematocrit during the febrile phase, whereas IFN-α levels negatively correlated with white blood cells during defervescence in severe dengue patients. Furthermore, previous serologic status of patients to DENV did not influence type I IFN production. CONCLUSIONS The distinct type I IFN profile in children with dengue and severe dengue, as well as its association with viral load, cytokine production and laboratory manifestations indicate differences in innate and adaptive immune responses that should be investigated further in order to unveil the association of immunological and physiological pathways that underlie in DENV infection.
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Affiliation(s)
- Laura B Talarico
- Fundación INFANT, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina.
| | - Alana B Byrne
- Fundación INFANT, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Sara Amarilla
- Department of Pediatrics, Instituto de Medicina Tropical, Asunción, Paraguay; National University of Asunción, Asunción, Paraguay
| | - Dolores Lovera
- Department of Pediatrics, Instituto de Medicina Tropical, Asunción, Paraguay; National University of Asunción, Asunción, Paraguay
| | | | | | - Patricio L Acosta
- Fundación INFANT, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | | | | | - Antonio Arbo
- Department of Pediatrics, Instituto de Medicina Tropical, Asunción, Paraguay; National University of Asunción, Asunción, Paraguay
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Lovera D, Amarilla S, Galeano F, Ávalos C, Peralta K, Apodaca S, Aguiar C, Arbo A. Neurologic syndrome associated with Zika postnatal acquisition. With regard to the first case in Paraguay. Rev Inst Med Trop 2016. [DOI: 10.18004/imt/201611236-41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Amarilla S, Avalos A, Suarez M, Marecos E, González E. PORCINE REPRODUCTIVE AND RESPIRATORY SYNDROME (PRRS): EPIDEMIOLOGY, SYMPTOMS AND LESIONS. Compend cienc vet 2016. [DOI: 10.18004/compend.cienc.vet.2015.05.02.38-46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Amarilla S, Aranda C, Martínez de Cuellar C, Araya S, Chamorro G, Kawabata A, Lovera D, Arbo A. Invasive Meningococcal Disease: 15 years of experience in a Reference Center. Rev Inst Med Trop 2016. [DOI: 10.18004/imt/201510119-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Amarilla S, Aranda C, Martínez de Cuellar C, Araya S, Chamorro G, Kawabata A, Lovera D, Arbo A. Enfermedad Meningocóccica Invasora: 15 años de Experiencia en un Centro de Referencia. Rev Inst Med Trop 2015. [DOI: 10.18004/imtgs/201510119-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Barranco I, Gómez-Laguna J, Rodríguez-Gómez I, Amarilla S, Ramis G, Salguero F, Carrasco L. Apoptosis in Lymphoid Tissues of Prrsv-infected Pigs Detected by Tunel and Cleaved Caspase-3 Immunohistochemistry. J Comp Pathol 2012. [DOI: 10.1016/j.jcpa.2011.11.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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