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Nunes PCG, de Filippis AMB, Lima MQDR, Faria NRDC, de Bruycker-Nogueira F, Santos JB, Heringer M, Chouin-Carneiro T, Couto-Lima D, de Santis Gonçalves B, Sampaio SA, de Araújo ESM, Sánchez-Arcila JC, dos Santos FB, Nogueira RMR. 30 years of dengue fatal cases in Brazil: a laboratorial-based investigation of 1047 cases. BMC Infect Dis 2018; 18:346. [PMID: 30053833 PMCID: PMC6062978 DOI: 10.1186/s12879-018-3255-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 07/13/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Dengue viruses (DENV) have emerged and reemerged in Brazil in the past 30 years causing explosive epidemics. The disease may range from clinically asymptomatic infections to severe and fatal outcomes. We aimed to describe the epidemiological, clinical and laboratorial aspects of the dengue fatal cases received by a Regional Reference Laboratory, Brazil in 30 years. METHODS A total of 1047 suspected fatal dengue cases were received from 1986 to 2015 and analyzed in the Laboratory of Flavivirus, FIOCRUZ. Suspected cases were submitted to viral detection, serological and molecular methods for cases confirmation. Influence of gender, age, serotype and type of infection (primary/secondary) on death outcome, as well the interactions between serotype and age or infection and age and type of infection were also studied. RESULTS A total of 359 cases (34.2%) were confirmed and DENV-1 (11.1%), DENV-2 (43.9%), DENV-3 (32.8%) and DENV-4 (13.7%) were detected. Overall, fatal cases occurred more often in primary infections (59.3%, p = 0.001). However, in 2008, fatal cases were mainly associated to secondary infections (p = 0.003). In 2008 and 2011, deaths were more frequent on children and those infected by DENV-2 presented a higher risk for fatal outcome. Moreover, children with secondary infections had a 4-fold higher risk for death. CONCLUSIONS Dengue is a multifactorial disease and, factors such as viral strain/serotype, occurrence of secondary infections and co-morbidities may lead to a severe outcome. However, the high dengue incidence and transmission during epidemics, such as those observed in Brazil may overwhelm and collapse the public health services, potentially impacting on increased disease severity and mortality.
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Affiliation(s)
- Priscila Conrado Guerra Nunes
- Viral Immunology Laboratory (LIV), Oswaldo Cruz Institute, IOC, FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
- Flavivirus Laboratory (LABFLA), Oswaldo Cruz Institute- FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
| | - Ana Maria Bispo de Filippis
- Flavivirus Laboratory (LABFLA), Oswaldo Cruz Institute- FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
| | - Monique Queiroz da Rocha Lima
- Viral Immunology Laboratory (LIV), Oswaldo Cruz Institute, IOC, FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
| | - Nieli Rodrigues da Costa Faria
- Flavivirus Laboratory (LABFLA), Oswaldo Cruz Institute- FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
| | - Fernanda de Bruycker-Nogueira
- Viral Immunology Laboratory (LIV), Oswaldo Cruz Institute, IOC, FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
| | - Jaqueline Bastos Santos
- Flavivirus Laboratory (LABFLA), Oswaldo Cruz Institute- FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
| | - Manoela Heringer
- Viral Immunology Laboratory (LIV), Oswaldo Cruz Institute, IOC, FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
| | - Thaís Chouin-Carneiro
- Viral Immunology Laboratory (LIV), Oswaldo Cruz Institute, IOC, FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
- Hematozoa Transmittors Mosquitoes Laboratory, Oswaldo Cruz Institute- FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
| | - Dinair Couto-Lima
- Hematozoa Transmittors Mosquitoes Laboratory, Oswaldo Cruz Institute- FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
| | - Bianca de Santis Gonçalves
- Flavivirus Laboratory (LABFLA), Oswaldo Cruz Institute- FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
| | - Simone Alves Sampaio
- Flavivirus Laboratory (LABFLA), Oswaldo Cruz Institute- FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
| | | | - Juan Camilo Sánchez-Arcila
- Viral Immunology Laboratory (LIV), Oswaldo Cruz Institute, IOC, FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
| | - Flávia Barreto dos Santos
- Viral Immunology Laboratory (LIV), Oswaldo Cruz Institute, IOC, FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
| | - Rita Maria Ribeiro Nogueira
- Flavivirus Laboratory (LABFLA), Oswaldo Cruz Institute- FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro, Brazil
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Lazar M, Perelygina L, Martines R, Greer P, Paddock CD, Peltecu G, Lupulescu E, Icenogle J, Zaki SR. Immunolocalization and Distribution of Rubella Antigen in Fatal Congenital Rubella Syndrome. EBioMedicine 2015; 3:86-92. [PMID: 26870820 PMCID: PMC4739417 DOI: 10.1016/j.ebiom.2015.11.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/21/2015] [Accepted: 11/26/2015] [Indexed: 11/08/2022] Open
Abstract
Background An estimated 100,000 cases of congenital rubella syndrome (CRS) occur worldwide each year. The reported mortality rate for infants with CRS is up to 33%. The cellular mechanisms responsible for the multiple congenital defects in CRS are presently unknown. Here we identify cell types positive for rubella virus (RV) in CRS infants. Methods Cells and organs involved in RV replication were identified in paraffin-embedded autopsy tissues from three fatal case-patients by histopathologic examination and immunohistochemical (IHC) staining using a rabbit polyclonal RV antibody. Normal rabbit antisera and RV antisera preabsorbed with highly purified RV served as negative controls. Results RV antigen was found in interstitial fibroblasts in the heart, adventitial fibroblasts of large blood vessels, alveolar macrophages, progenitor cells of the outer granular layer of the brain, and in capillary endothelium and basal plate in the placenta. The antibody specificity was verified by IHC staining of multiple tissue sections from other infectious disease cases. RV infection of each cell type is consistent with abnormalities which have been identified in patients with CRS, in the heart, large blood vessels, and brain. Antigen distribution was consistent with inflammatory response to vascular injury and systemic spread of RV. Conclusions The identification of RV positive cell types in CRS is important to better understand the pathology and pathogenesis of CRS. Autopsy tissues from three fatal CRS cases were analyzed immunohistochemically. Rigorous negative controls were used to verify the specificity of immunostaining. Rubella antigen was detected in cardiac fibroblasts, alveolar macrophages, neuronal progenitor cells and endothelial cells. Rubella antigen localization was consistent with CRS pathology. Wild type rubella virus (RV) transferred from mothers with rubella to their unborn children results in 100,000 infants/year worldwide born with birth defects collectively known as congenital rubella syndrome (CRS). Indeed, RV is the most teratogenic infectious agent known. Identifying cell types involved in RV infection of infants with CRS was possible using tissues from three Romanian infants, who unfortunately died, and using a very specific antiserum to RV. The cell types involved in RV infection which were identified were consistent with the pathology of CRS. Additional studies further enumerating the cell types involved in CRS are needed.
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Affiliation(s)
- Mihaela Lazar
- Measles, Mumps, Rubella and Herpesvirus Laboratory Branch, Division of Viral Diseases, 1600 Clifton Rd, Atlanta, GA, USA; National Laboratory for Measles and Rubella, National Institute of Research-Development for Microbiology and Immunology "Cantacuzino", 103 Splaiul Independenței, Bucharest, Romania; Department of Biology, University of Bucharest, 4-12 Blvd. Regina Elisabeta, Bucharest, Romania
| | - Ludmila Perelygina
- Measles, Mumps, Rubella and Herpesvirus Laboratory Branch, Division of Viral Diseases, 1600 Clifton Rd, Atlanta, GA, USA
| | - Roosecelis Martines
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA
| | - Patricia Greer
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA
| | - Christopher D Paddock
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA
| | - Gheorghe Peltecu
- Filantropia Clinical Hospital, 11-13 Blvd. Ion Mihalache, Bucharest, Romania
| | - Emilia Lupulescu
- National Laboratory for Measles and Rubella, National Institute of Research-Development for Microbiology and Immunology "Cantacuzino", 103 Splaiul Independenței, Bucharest, Romania
| | - Joseph Icenogle
- Measles, Mumps, Rubella and Herpesvirus Laboratory Branch, Division of Viral Diseases, 1600 Clifton Rd, Atlanta, GA, USA.
| | - Sherif R Zaki
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA
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