Sequential serological surveys in the early stages of the coronavirus disease epidemic: limitations and perspectives.

INTRODUCTION: Estimates of the number of individuals infected by severe acute respiratory syndrome coronavirus 2 are important for health planning and establishment of expectations regarding herd immunity. METHODS: Seven testing rounds of a serological survey were conducted at 1-week intervals between April 19 and May 31, 2020 in Teresina municipality. RESULTS Over the 7 weeks, serological positivity increased from 0.56% (95% confidence interval [CI]: 0.18%-1.30%) to 8.33% (95% CI: 6.61%-10.33%), representing 33-53 persons infected for each reported case. CONCLUSIONS: Serological screening may be an important tool for understanding the immunity of a population and planning community interventions.

Sequential serological surveys in the early stages of the coronavirus disease epidemic: limitations and perspectives

Abstract INTRODUCTION: Estimates of the number of individuals infected by severe acute respiratory syndrome coronavirus 2 are important for health planning and establishment of expectations regarding herd immunity. METHODS: Seven testing rounds of a serological survey were conducted at 1-week intervals between April 19 and May 31, 2020 in Teresina municipality. RESULTS Over the 7 weeks, serological positivity increased from 0.56% (95% confidence interval [CI]: 0.18%-1.30%) to 8.33% (95% CI: 6.61%-10.33%), representing 33-53 persons infected for each reported case. CONCLUSIONS: Serological screening may be an important tool for understanding the immunity of a population and planning community interventions.

Potential role of dengue virus, chikungunya virus and Zika virus in neurological diseases.

This study showed that laboratory markers of recent infection by dengue, Zika or chikungunya arboviruses were detected in the biological samples of approximately one-third of patients with encephalitis, myelitis, encephalomyelitis or Guillain-Barré syndrome, in a surveillance programme in Piauí state, Brazil, between 2015-2016. Fever and myalgia had been associated with these cases. Since in non-tropical countries most infections or parainfectious diseases associated with the nervous system are attributed to herpesviruses, enteroviruses, and Campylobacter jejuni, the present findings indicate that in tropical countries, arboviruses may now play a more important role and reinforce the need for their surveillance and systematic investigation in the tropics.

Proposal for a simplified approach to suspected meningitis case diagnosis: experience report of a reference service in the state of Piauí, Brazil, 2007-2016. / Proposta de abordagem simplificada para suspeitas de meningites: relato de experiência de serviço de referência no estado do Piauí, 2007-2016.

OBJECTIVE: to describe a simplified protocol to diagnose suspected cases of meningitis. METHODS: this is an experience report on the approach to diagnosing meningitis at the Tropical Diseases Reference Service in the state of Piauí, Brazil, between 2007 and 2016; information was extracted from the Notifiable Diseases Information System (SINAN) and the laboratory record book; the chi-square test was used to compare epidemiological surveillance indicators based on final meningitis case classification; the Phi coefficient was used to verify the correlation between presumed diagnosis and laboratory-confirmed diagnosis. RESULTS: considering the 4,096 cases of meningitis investigated, there was a reduction in the generic classification of meningitis cases from 72% to 47% (p<0.001); indicated laboratory investigation profile showed agreement with final meningitis case diagnosis. (rf=0.66; p<0.001). CONCLUSION: a greater proportion of specific etiologic diagnosis of meningitis was achieved while the protocol was in use.

Encephalitis associated with Zika virus infection and reactivation of the varicella-zoster virus in a Brazilian child.

We report a case of encephalitis associated with Zika virus infection and reactivation of varicella-zoster virus in the central nervous system of a Brazilian child. This case raises the possibility that reactivation of the latent varicella-zoster virus may be a mechanism of neurological impairment induced by acquired Zika virus infection.

Encephalitis associated with Zika virus infection and reactivation of the varicella-zoster virus in a Brazilian child

Abstract We report a case of encephalitis associated with Zika virus infection and reactivation of varicella-zoster virus in the central nervous system of a Brazilian child. This case raises the possibility that reactivation of the latent varicella-zoster virus may be a mechanism of neurological impairment induced by acquired Zika virus infection.

Microcephaly in Piauí, Brazil: descriptive study during the Zika virus epidemic, 2015-2016. / Microcefalia no Piauí, Brasil: estudo descritivo durante a epidemia do vírus Zika, 2015-2016.

OBJECTIVE: to describe the occurrence and characteristics of microcephaly cases in Piauí, Brazil, during an epidemic of Zika virus infection in 2015-2016. METHODS: descriptive study using data of live births from January/2015 to January/2016, obtained from the Information System on Live Births (Sinasc), the Public Health Events Registry (RESP) and the active search for medical records; mothers and live births were tested for dengue, chikungunya, and Zika, besides syphilis, toxoplasmosis, rubella, cytomegalovirus, and herpes (STORCH). RESULTS: of the 75 microcephaly cases, 34 were related to congenital infectious process; microcephaly prevalence was of 13.6/10 thousand live births; imaging exams confirmed that 34 live births presented calcifications, 23 had cerebral atrophies, 14 had lissencephaly, 12 had ventriculomegaly and 6 had dysgenesis; none tested positive for STORCH, dengue or chikungunya; 1 was IgM positive for Zika. CONCLUSION: there was an outbreak of microcephaly in Piauí, possibly related to infection during pregnancy Zika virus.

Proposta de abordagem simplificada para suspeitas de meningites: relato de experiência de serviço de referência no estado do Piauí, 2007-2016 / Propuesta para el enfoque inicial simplificado de las sospechas de meningitis: relato de experiencia de servicio de referencia en el estado de Piauí, Brasil, 2007-2016 / Proposal for a simplified approach to suspected meningitis case diagnosis: experience report of a reference service in the state of Piauí, Brazil, 2007-2016

Objetivo: descrever um protocolo simplificado para abordagem de casos suspeitos de meningite. Métodos: relato de experiência na abordagem diagnóstica das meningites no serviço de referência em doenças tropicais do estado do Piauí, Brasil, no período de 2007-2016; extraíram-se informações do Sistema de Informação de Agravos de Notificação (Sinan) e do livro de registro do laboratório; utilizou-se o teste do qui-quadrado para comparar os indicadores da vigilância epidemiológica baseados na classificação final dos casos de meningite; utilizou-se o teste de concordância Phi para verificar a correlação entre os diagnósticos etiológicos presumidos pelo protocolo e aqueles confirmados laboratorialmente. Resultados: considerando-se 4.096 casos de meningite estudados, houve redução na classificação genérica desses casos, de 72 para 47% (p<0,001); a indicação do perfil de investigação laboratorial mostrou concordância com o diagnóstico final dos casos de meningite (rf=0,66; p<0,001). Conclusão: o diagnóstico etiológico específico das meningites foi alcançado em maior proporção durante a utilização do protocolo.

Objetivo: describir un protocolo para el abordaje de casos sospechosos de meningitis. Métodos: se relata la experiencia del diagnóstico de meningitis en el servicio de referencia para enfermedades tropicales del estado de Piauí, Brasil, entre 2007 y 2016; extrajimos informaciones del Sistema de Información de Notificación (Sinan) y del libro de laboratorio; la prueba de chi-cuadrado verificó la alteración de los indicadores de la vigilancia epidemiológica basados en la clasificación de los casos de meningitis; usamos la prueba de concordancia Phi para correlacionar los diagnósticos etiológicos presumidos por el protocolo y aquellos confirmados laboratorialmente. Resultados: considerando los 4.096 casos de meningitis investigados, se observó reducción en la clasificación genérica de casos del 72 al 47% (p<0,001); la selección del perfil de investigación mostró concordancia con la clasificación final de los casos de meningitis (rf=0,66; p<0,001). Conclusión: el diagnóstico etiológico de las meningitis se alcanzó en mayor proporción durante la utilización del protocolo.

Objective: to describe a simplified protocol to diagnose suspected cases of meningitis. Methods: this is an experience report on the approach to diagnosing meningitis at the Tropical Diseases Reference Service in the state of Piauí, Brazil, between 2007 and 2016; information was extracted from the Notifiable Diseases Information System (SINAN) and the laboratory record book; the chi-square test was used to compare epidemiological surveillance indicators based on final meningitis case classification; the Phi coefficient was used to verify the correlation between presumed diagnosis and laboratory-confirmed diagnosis. Results: considering the 4,096 cases of meningitis investigated, there was a reduction in the generic classification of meningitis cases from 72% to 47% (p<0.001); indicated laboratory investigation profile showed agreement with final meningitis case diagnosis. (rf=0.66; p<0.001). Conclusion: a greater proportion of specific etiologic diagnosis of meningitis was achieved while the protocol was in use.

Microcefalia no Piauí, Brasil: estudo descritivo durante a epidemia do vírus Zika, 2015-2016 / Microcefalia en Piauí, Brasil: estudio descriptivo durante la epidemia del virus Zika, 2015-2016 / Microcephaly in Piauí, Brazil: descriptive study during the Zika virus epidemic, 2015-2016

OBJETIVO: descrever a ocorrência e as características dos casos de microcefalia no Piauí, Brasil, durante epidemia do vírus Zika em 2015-2016. MÉTODOS: estudo descritivo com dados dos nascidos vivos no período de janeiro/2015 a janeiro/2016, obtidos do Sistema de Informações sobre Nascidos Vivos (Sinasc), do Registro de Eventos em Saúde Pública (RESP) e de busca ativa em prontuários; mães e nascidos vivos foram testados para dengue, chikungunya e Zika, além de sífilis, toxoplasmose, rubéola, citomegalovírus e herpes (STORCH). RESULTADOS: dos 75 casos de microcefalia, 34 foram relacionados a processo infeccioso congênito; a prevalência de microcefalia foi de 13,6/10 mil nascidos vivos; exames de imagem confirmaram que 34 nascidos vivos apresentavam calcificações, 23 atrofias cerebrais, 14 lisencefalia, 12 ventriculomegalia e 6 digenesias; nenhum apresentou resultado positivo para STORCH, dengue ou chikungunya; 1 referiu Zika IgM reagente. CONCLUSÃO: houve surto de microcefalia no Piauí, possivelmente relacionado à infecção gestacional pelo vírus Zika.

OBJETIVO: describir la ocurrencia y las características de los casos de microcefalia en Piauí, Brasil, durante la epidemia de infección por virus Zika en 2015-2016. MÉTODOS: Estudio descriptivo incluyendo datos del Sistema de Información de Nacidos Vivos (Sinasc) y del Registro de Eventos en Salud Pública (RESP), entre enero/2015 y enero/2016; las madres fueron testadas para dengue, chikungunya, zika y STORCH. RESULTADOS: 75 recién nacidos (RN) presentaron microcefalias; de estos, 34 tenían microcefalia relacionada con una infección; la prevalencia de microcefalia fue de 13,6 casos/10.000 nacidos vivos; imágenes confirmaron que 34 RN presentaron calcificaciones, 23 atrofia cerebral, 14 lisencefalias, 12 ventriculomegalias y 6 disgenesias; ningún RN presentó STORCH, dengue o chikungunya, y 1 fue reactivo para Zika (IgM). CONCLUSIÓN: hubo un brote de microcefalia en Piauí posiblemente relacionado con infección materna previa por virus Zika.

OBJECTIVE: to describe the occurrence and characteristics of microcephaly cases in Piauí, Brazil, during an epidemic of Zika virus infection in 2015-2016. METHODS: descriptive study using data of live births from January/2015 to January/2016, obtained from the Information System on Live Births (Sinasc), the Public Health Events Registry (RESP) and the active search for medical records; mothers and live births were tested for dengue, chikungunya, and Zika, besides syphilis, toxoplasmosis, rubella, cytomegalovirus, and herpes (STORCH). RESULTS: of the 75 microcephaly cases, 34 were related to congenital infectious process; microcephaly prevalence was of 13.6/10 thousand live births; imaging exams confirmed that 34 live births presented calcifications, 23 had cerebral atrophies, 14 had lissencephaly, 12 had ventriculomegaly and 6 had dysgenesis; none tested positive for STORCH, dengue or chikungunya; 1 was IgM positive for Zika. CONCLUSION: there was an outbreak of microcephaly in Piauí, possibly related to infection during pregnancy Zika virus.

Soap bubble appearance in brain magnetic resonance imaging: cryptococcal meningoencephalitis.

Although cryptococcal infections begin in the lungs, meningoencephalitis is the most frequently encountered manifestation of cryptococcosis among individuals with advanced immunosuppression. As the infection progresses along the Virchow-Robin spaces, these structures may become dilated with mucoid material produced by the capsule of the organism. We report a case of a 24-year-old man with cryptococcal meningoencephalitis in which magnetic resonance imaging showed clusters of gelatinous pseudocysts in the periventricular white matter, basal ganglia, mammillary bodies, midbrain peduncles and nucleus dentatus with a soap bubble appearance.

Soap bubble appearance in brain magnetic resonance imaging: cryptococcal meningoencephalitis

Although cryptococcal infections begin in the lungs, meningoencephalitis is the most frequently encountered manifestation of cryptococcosis among individuals with advanced immunosuppression. As the infection progresses along the Virchow-Robin spaces, these structures may become dilated with mucoid material produced by the capsule of the organism. We report a case of a 24-year-old man with cryptococcal meningoencephalitis in which magnetic resonance imaging showed clusters of gelatinous pseudocysts in the periventricular white matter, basal ganglia, mammillary bodies, midbrain peduncles and nucleus dentatus with a soap bubble appearance.

Spinal cord injury: epidemiological study of 386 cases with emphasis on those patients admitted more than four hours after the trauma.

We studied 386 cases of spinal cord injury to analyze the follow up of the patients admitted most of the time more than four hours, the majority of the injuries happening far from the attending health service and first specialized care received long after the accident. This is a clinical study based on data collected during hospitalization of the patients, operated or not, in a Brazilian public health service. The lesion mainly seen was fracture and dislocation, isolated or on multiple levels, and the most important clinical complications were due to respiratory failure and hypotension, especially because 73.8% were from outside and they were admitted more then four hours after the trauma. The mortality rate was 11.9%, but just 2.1% had undergone a surgery. The complications resulted in major risk of death when the trauma was at the cervical level and the patients were over 50 years old, especially when admitted more than four hours after the trauma. We emphasize the importance of the first health care concerning the clinical treatment, aiming to reduce the mortality rate.