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1.
Ocul Immunol Inflamm ; : 1-5, 2021 Apr 07.
Artículo en Inglés | MEDLINE | ID: mdl-33826478

RESUMEN

Purpose: To describe four cases of ocular adverse events resembling intraocular inflammatory and non-inflammatory conditions following yellow fever vaccination (YFV) during a recent yellow fever (YF) outbreak in Brazil.Methods: Charts of patients diagnosed with ocular adverse events after YFV between January 2017 and January 2019 at two tertiary referral centers in Brazil.Results: Four patients (two adults and two children) are reported. Case 1 presented with typical findings of central serous chorioretinopathy which resolved spontaneously; case 2 was diagnosed with acute Vogt-Koyanagi-Harada disease; cases 3 and 4 had bilateral diffuse retinal vasculitis. In the absence of infectious and noninfectious disorders, the temporal association between stand-alone YFV and onset of ocular symptoms within 15 days was interpreted as evidence of causation.Conclusions: Clinicians should be aware of the wide spectrum of possible ocular adverse reactions to stand-alone YFV.

2.
Viruses ; 13(4)2021 Mar 31.
Artículo en Inglés | MEDLINE | ID: mdl-33807442

RESUMEN

Flaviviruses circulate worldwide and cause a number of medically relevant human diseases, such as dengue, Zika, yellow fever, and tick-borne encephalitis (TBE). Serology plays an important role in the diagnosis of flavivirus infections, but can be impeded by antigenic cross-reactivities among flaviviruses. Therefore, serological diagnosis of a recent infection can be insufficiently specific, especially in areas where flaviviruses co-circulate and/or vaccination coverage against certain flaviviruses is high. In this study, we developed a new IgM assay format, which is well suited for the specific diagnosis of TBE, Zika and dengue virus infections. In the case of TBE and Zika, the IgM response proved to be highly specific for the infecting virus. In contrast, primary dengue virus infections induced substantial amounts of cross-reactive IgM antibodies, which is most likely explained by structural peculiarities of dengue virus particles. Despite the presence of cross-reactive IgM, the standardized nature and the quantitative read-out of the assay even allowed the serotype-specific diagnosis of recent dengue virus infections in most instances.

3.
Artículo en Inglés | MEDLINE | ID: mdl-33813107

RESUMEN

BACKGROUND: We lack the rationale on which to base the development of a yellow fever (YF) vaccination schedule for people living with HIV (PLHIV). OBJECTIVES: Report on the current evidence regarding the seroconversion rate and the duration of humoral protection after YF vaccine, as well as the impact of revaccination in PLWHIV. DATA SOURCES: MEDLINE, Google Scholar, LILACS and Cochrane CENTRAL were searched. METHODS: Population: We selected studies on PLWHIV of all ages (including perinatally HIV-infected patients) and all settings (YF endemic and non-endemic zones). INTERVENTION: Vaccination against YF, at least once after the HIV diagnosis. The research questions were the seroconversion rate, duration of humoral immunity after YF vaccine and impact of revaccination in PLWHIV. Selected studies were assessed for quality using the Newcastle-Ottawa scale. RESULTS: Ten, six and six studies were selected for the systematic review of each question, respectively. Only one study addressed the first question in perinatally HIV- infected children. The quality of the studies was assessed as Poor (n=16), Fair (n=2) or Good (n=4). A meta-analysis demonstrated that 97.6% (95%CI 91.6-100) of the included population seroconverted. Between 1 and 10 years after YF vaccine, reported persistence of neutralizing antibodies was 72% (95%IC 53.6-91), and 62% (95%IC 45.4-78.6) more than 10 years after YF vaccine. No conclusions could currently be drawn on impact of revaccination due to small number of patients. CONCLUSIONS: The current evidence regarding seroconversion rate, duration of humoral protection after YF vaccine and impact of revaccination in PLWHIV is limited by the low number and quality of studies. Based on the presently available data, it is difficult to rationally develop yellow fever vaccination guidelines for PLWHIV.

4.
Trop Med Int Health ; 2021 Apr 04.
Artículo en Inglés | MEDLINE | ID: mdl-33813766

RESUMEN

The sanitary problem of Aedes aegypti mosquito acquires relevance around the world because it is the vector of dengue, zika, chikungunya, and yellow fever. The vector is adapting to southern regions faster and the propagation of these diseases in urban areas is a complex problem for society. We aimed to contribute to the risk prevention of disease transmission in the Metropolitan Area of Buenos Aires, through monitoring Aedes aegypti population-levels and developing education campaigns with government agencies and society participation. Monitoring activities aimed to diagnostic the presence of the vector and its ecology behavior, and to generate education and prevention politics to avoid its propagation. The results show that (1) the mosquito is in the territory and it is spreading, (2) prevention activities of the municipalities are insufficient to generate an effective sanitary response, and (3) it is necessary to improve the education programs to the population about the life cycle of the vector. The integration of university, government, and society improved the work of the team because it combined knowledge about vector ecology, diseases, and territory characteristics.

5.
J Med Primatol ; 2021 Apr 04.
Artículo en Inglés | MEDLINE | ID: mdl-33817795

RESUMEN

Herein, we describe a unique case of concomitant angioinvasive pulmonary aspergillosis due to Aspergillus fumigatus and yellow fever in a free-ranging howler monkey (Alouatta sp). Lung samples were negative for influenza viruses A and B.

6.
Cell Host Microbe ; 2021 Mar 29.
Artículo en Inglés | MEDLINE | ID: mdl-33794184

RESUMEN

Argonaute (AGO) proteins bind small RNAs to silence complementary RNA transcripts, and they are central to RNA interference (RNAi). RNAi is critical for regulation of gene expression and antiviral defense in Aedes aegypti mosquitoes, which transmit Zika, chikungunya, dengue, and yellow fever viruses. In mosquitoes, AGO1 mediates miRNA interactions, while AGO2 mediates siRNA interactions. We applied AGO-crosslinking immunoprecipitation (AGO-CLIP) for both AGO1 and AGO2, and we developed a universal software package for CLIP analysis (CLIPflexR), identifying 230 small RNAs and 5,447 small RNA targets that comprise a comprehensive RNAi network map in mosquitoes. RNAi network maps predicted expression levels of small RNA targets in specific tissues. Additionally, this resource identified unexpected, context-dependent AGO2 target preferences, including endogenous viral elements and 3'UTRs. Finally, contrary to current thinking, mosquito AGO2 repressed imperfect targets. These findings expand our understanding of small RNA networks and have broad implications for the study of antiviral RNAi.

7.
Microb Ecol ; 2021 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-33797563

RESUMEN

Host-microbiome dynamics occurring in the yellow fever mosquito (Aedes aegypti) contribute to host life history traits, and particular bacterial taxa are proposed to comprise a "core" microbiota that influences host physiology. Laboratory-based studies are frequently performed to investigate these processes; however, experimental results are often presumed to be generalizable across laboratories, and few efforts have been made to independently reproduce and replicate significant findings. A recent study by Muturi et al. (FEMS Microbiol Ecol 95 (1):213, 2019) demonstrated the food source imbibed by laboratory-reared adult female mosquitoes significantly impacted the host-associated microbiota-a foundational finding in the field of mosquito biology worthy of independent evaluation. Here, we coalesce these data with two additional mosquito-derived 16S rRNA gene sequence data sets using a unifying bioinformatics pipeline to reproduce the characterization of these microbiota, test for a significant food source effect when independent samples were added to the analyses, assess whether similarly fed mosquito microbiomes were comparable across laboratories, and identify conserved bacterial taxa. Our pipeline characterized similar microbiome composition and structure from the data published previously, and a significant food source effect was detected with the addition of independent samples, increasing the robustness of this previously discovered component of mosquito biology. However, distinct microbial communities were identified from similarly fed but independently reared mosquitoes, and surveys across all samples did not identify conserved bacterial taxa. These findings demonstrated that while the main effect of the food source was supported, laboratory-specific conditions may produce inherently differential microbiomes across independent laboratory environments.

8.
Pregunta y respuesta en Portugués | SOF - Segunda Opinión Formativa | ID: sof-43779

RESUMEN

Orienta-se a notificação do caso, solicitação de exames para controle, observação domiciliar e avaliação médica diária com registro em prontuário por, no mínimo, 21 dias(1).

Os exames que devem ser solicitados são hemograma, TAP, TTPA, bilirrubinas totais e frações, creatinina, TGO e TGP(1).


Asunto(s)
Vacuna contra la Fiebre Amarilla/administración & dosificación , Errores de Medicación , Salud del Niño
9.
Sci Rep ; 11(1): 6081, 2021 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-33727688

RESUMEN

Although there are many studies on the control of mosquito vectors of the yellow fever virus (YFV) in tropical forests, there are still few ecological studies regarding abiotic factors effect on these mosquitoes. Here we characterize these effects on oviposition behavior, abundance, and diversity of mosquito vectors of YFV. The study was conducted in Córrego da Luz Municipal Park, in Casimiro de Abreu, Rio de Janeiro state, Brazil, from July 2018 to December 2019. Ovitraps were placed at ground level and 3 m high. The data were tested for normality using the Shapiro-Wilk test, followed by an independent sample analysis, the Mann-Whitney test. The Shannon Diversity Index was used to evaluate the abundance of mosquitos' eggs collected at both ground level and 3 m high. We highlight the presence of Haemagogus janthinomys and Hg. leucocelaenus, primary YFV vectors in forest areas. The abundance of Hg. leucocelaenus (63%), Hg. janthinomys (75%), and Aedes terrens (58%) was higher at the height of 3 m, while Ae. albopictus (52%) was higher at ground level. Aedes albopictus was positively correlated with temperature. Culicidae monitoring is essential for assessing the YFV transmission cycle in Atlantic forest fragments.

10.
BMC Infect Dis ; 21(1): 265, 2021 Mar 17.
Artículo en Inglés | MEDLINE | ID: mdl-33731022

RESUMEN

BACKGROUND: Increasing arbovirus infections have been a global burden in recent decades. Many countries have experienced the periodic emergence of arbovirus diseases. However, information on the prevalence of arboviruses is largely unknown or infrequently updated because of the lack of surveillance studies, especially in Africa. METHODS: A surveillance study was conducted in Gabon, Central Africa, on arboviruses, which are a major public health concern in Africa, including: West Nile virus (WNV), dengue virus (DENV), Zika virus (ZIKV), yellow fever virus (YFV), chikungunya virus (CHIKV), and Rift Valley fever virus (RVFV). Serological and molecular assays were performed to investigate past infection history and the current status of infection, using serum samples collected from healthy individuals and febrile patients, respectively. RESULTS: The overall seroprevalence during 2014-2017 was estimated to be 25.3% for WNV, 20.4% for DENV, 40.3% for ZIKV, 60.7% for YFV, 61.2% for CHIKV, and 14.3% for RVFV. No significant differences were found in the seroprevalence of any of the viruses between the male and female populations. However, a focus on the mean age in each arbovirus-seropositive individual showed a significantly younger age in WNV- and DENV-seropositive individuals than in CHIKV-seropositive individuals, indicating that WNV and DENV caused a relatively recent epidemic in the region, whereas CHIKV had actively circulated before. Of note, this indication was supported by the detection of both WNV and DENV genomes in serum samples collected from febrile patients after 2016. CONCLUSIONS: This study revealed the recent re-emergence of WNV and DENV in Gabon as well as the latest seroprevalence state of the major arboviruses, which indicated the different potential risks of virus infections and virus-specific circulation patterns. This information will be helpful for public health organizations and will enable a rapid response towards these arbovirus infections, thereby preventing future spread in the country.

11.
Malar J ; 20(1): 165, 2021 Mar 24.
Artículo en Inglés | MEDLINE | ID: mdl-33761967

RESUMEN

Malaria is a principal cause of illness and death in countries where the disease is endemic. Personal protection against mosquitoes using repellents could be a useful method that can reduce and/or prevent transmission of mosquito-borne diseases. The available repellent products, such as creams, roll-ons, and sprays for personal protection against mosquitoes, lack adequate long-term efficacy. In most cases, they need to be re-applied or replaced frequently. The encapsulation and release of the repellents from several matrices has risen as an alternative process for the development of invention of repellent based systems. The present work reviews various studies about the development and use of repellent controlled-release formulations such as polymer microcapsules, polymer microporous formulations, polymer micelles, nanoemulsions, solid-lipid nanoparticles, liposomes and cyclodextrins as new tools for mosquito-borne malaria control in the outdoor environment. Furthermore, investigation on the mathematical modelling used for the release rate of repellents is discussed in depth by exploring the Higuchi, Korsmeyer-Peppas, Weibull models, as well as the recently developed Mapossa model. Therefore, the studies searched suggest that the final repellents based-product should not only be effective against mosquito vectors of malaria parasites, but also reduce the biting frequency of other mosquitoes transmitting diseases, such as dengue fever, chikungunya, yellow fever and Zika virus. In this way, they will contribute to the improvement in overall public health and social well-being.

12.
Med Vet Entomol ; 2021 Mar 29.
Artículo en Inglés | MEDLINE | ID: mdl-33780011

RESUMEN

Aedes aegypti (L.) (Diptera: Culicidae) is a vector of several serious disease-causing viruses including Dengue, Zika, chikungunya and yellow fever. Effective and efficient trapping methods are essential for meaningful mosquito population and disease-presence surveillance and ultimately, vector control. The Fay-Prince trap (FPT) was developed in the late 1960s as a daytime visual trap for male Ae. aegypti. Since then, its use has been expanded into the trapping of female Ae. aegypti, Aedes albopictus Skuse, other Ae. spp., and Culex spp. The efficiency of the FPT alone and with CO2 was tested under semi-field conditions and the behaviour of responding female Ae. aegypti was characterized. The mean capture efficiency of the FPT with CO2 per 30 min in the greenhouse was 3.07% and the capture rate from the total number of mosquitoes in our semi-field setup was slightly higher at 4.45%. Understanding the behaviours that mosquitoes exhibit during their encounter with particularly a visual trap may recommend trap improvements and contributes to our understanding of host-seeking behaviour and how it might be exploited.

13.
Curr Opin Virol ; 47: 106-112, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33721656

RESUMEN

The Flaviviridae family comprises important human pathogens, including Dengue, Zika, West Nile, Yellow Fever and Japanese Encephalitis viruses. The viral genome, a positive-sense single-stranded RNA, is packaged by a single protein, the capsid protein, which is a small and highly basic protein that form intertwined homodimers in solution. Atomic-resolution structures of four flaviviruses capsid proteins were solved either in solution by nuclear magnetic resonance spectroscopy, or after protein crystallization by X-ray diffraction. Analyses of these structures revealed very particular properties, namely (i) the predominance of quaternary contacts maintaining the structure; (ii) a highly electropositive surface throughout the protein; and (iii) a flexible helix (α1). The goal of this review is to discuss the role of these features in protein structure-function relationship.

14.
Bol. malariol. salud ambient ; 61(1): 21-28, 10 de marzo de 2021.
Artículo en Español, Inglés | LILACS-Express | LILACS | ID: biblio-1177399

RESUMEN

Las Enfermedades de Transmisión Vectorial contribuyen de manera importante a la carga mundial de morbilidad afectando de manera especial a las poblaciones de los países en desarrollo. Ecuador es un país tropical, con condiciones climáticas favorables a para albergar mosquitos de las especies Aedes que son vectores activos de arbovirosis como el dengue, el zika, el chikungunya y la fiebre amarilla para las no existe un tratamiento específico ni métodos efectivos de inmunización, y la única forma de controlar la transmisión está dirigida hacia sus vectores. El uso de insecticidas químicos ha sido la forma más utilizada en los programas de Control, siendo Temephos, Deltametrina y Malathion los más comunes en Ecuador en la actualidad. El uso de los insecticidas tiene un efecto dual sobre la salud pública: Positivo, gracias al control que brinda a los vectores transmisores de ETV; y Negativo, traducido en los riesgos para la salud de trabajadores expuestos directamente y de la población en general causando efectos agudos y crónicos. El reconocimiento como trabajo de alto riesgo a la tarea de los fumigadores de Ecuador dado por el mayor ente ambiental del país, permite que se tomen las acciones necesarias para garantizar su salud y de ésta manera pueda verse reducido el impacto negativo, adoptando mejores y más eficientes métodos y equipos que sean seguros en la aplicación de insecticidas de control vectorial.


Vector-borne diseases contribute significantly to the global burden of disease, particularly affecting populations in developing countries. Ecuador is a tropical country, with favorable climatic conditions to house mosquitoes of Aedes species that are active vectors of arbovirosis such as dengue, Zika, chikungunya and yellow fever for which there is no specific treatment or effective method of immunization, and the only way to control transmission is to target their vectors. The use of chemical insecticides has been the most used form in Control programs, being Temephos, Deltametrina and Malathion the most common in Ecuador today. The use of insecticides has a dual effect on public health: Positive, thanks to the control provided to ETV transmitter vectors; and Negative, translated into the health risks to directly exposed workers and the general population causing acute and chronic effects. The recognition as high-risk work of the work of the Ecuadorian fumigators given by the largest environmental entity in the country, allows the necessary actions to be taken to guarantee their health and in this way the negative impact can be reduced, adopting better and more efficient methods and equipment that are safe in the application of vector control insecticides.

15.
Trop Dis Travel Med Vaccines ; 7(1): 7, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33712073

RESUMEN

BACKGROUND: Yellow Fever (YF) immunization required a single dose vaccine with boosters every 10 years. After International Health Regulation (IHR) amendment annex 7 (July 2016), it was accepted that a single dose confers lifelong immunity. Since pre-travel advice is as important as vaccination when traveling, it is essential to clarify why travelers come to a travel health consultation, with the possibility of IHR amendment having a negative impact on travelers' health. This study aims to describe travelers' reasons to come to a pre-travel consultation in Lisbon and if they would return if they wouldn't need the YF vaccine booster. METHODS: An observational cross-sectional study was conducted during 5 months in the waiting room of Instituto de Higiene e Medicina Tropical travel clinic in Lisbon, Portugal. Travelers were asked about sociodemographic characteristics, destination country, travel duration and reasons to travel in an anonymous self-administered questionnaire. RESULTS: A total of 1043 travelers agreed to participate in the study. Although 61.0% (627/1028) did not come to the clinic to get the YF vaccine, from those who did, 36.7% (133/362) would not come and 12.9% (47/362) didn't knew if they would come if the vaccine would not be necessary. CONCLUSION: The IHR amendment may have a negative impact on travel clinic attendance and on travelers´ health.

16.
Front Immunol ; 12: 640190, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33717194

RESUMEN

The epidemic spread of Zika virus (ZIKV), associated with devastating neurologic syndromes, has driven the development of multiple ZIKV vaccines candidates. An effective vaccine should induce ZIKV-specific T cell responses, which are shown to improve the establishment of humoral immunity and contribute to viral clearance. Here we investigated how previous immunization against Japanese encephalitis virus (JEV) and yellow fever virus (YFV) influences T cell responses elicited by a Zika purified-inactivated virus (ZPIV) vaccine. We demonstrate that three doses of ZPIV vaccine elicited robust CD4 T cell responses to ZIKV structural proteins, while ZIKV-specific CD4 T cells in pre-immunized individuals with JEV vaccine, but not YFV vaccine, were more durable and directed predominantly toward conserved epitopes, which elicited Th1 and Th2 cytokine production. In addition, T cell receptor repertoire analysis revealed preferential expansion of cross-reactive clonotypes between JEV and ZIKV, suggesting that pre-existing immunity against JEV may prime the establishment of stronger CD4 T cell responses to ZPIV vaccination. These CD4 T cell responses correlated with titers of ZIKV-neutralizing antibodies in the JEV pre-vaccinated group, but not in flavivirus-naïve or YFV pre-vaccinated individuals, suggesting a stronger contribution of CD4 T cells in the generation of neutralizing antibodies in the context of JEV-ZIKV cross-reactivity.

17.
Elife ; 102021 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-33722340

RESUMEN

Yellow fever (YF) is a viral, vector-borne, haemorrhagic fever endemic in tropical regions of Africa and South America. The vaccine for YF is considered safe and effective, but intervention strategies need to be optimised; one of the tools for this is mathematical modelling. We refine and expand an existing modelling framework for Africa to account for transmission in South America. We fit to YF occurrence and serology data. We then estimate the subnational forces of infection for the entire endemic region. Finally, using demographic and vaccination data, we examine the impact of vaccination activities. We estimate that there were 109,000 (95% credible interval [CrI] [67,000-173,000]) severe infections and 51,000 (95% CrI [31,000-82,000]) deaths due to YF in Africa and South America in 2018. We find that mass vaccination activities in Africa reduced deaths by 47% (95% CrI [10%-77%]). This methodology allows us to evaluate the effectiveness of vaccination and illustrates the need for continued vigilance and surveillance of YF.

18.
Artículo en Inglés | MEDLINE | ID: mdl-33761167

RESUMEN

Yellow fever is a vaccine-preventable acute viral disease that can rapidly spread and cause serious public health impact. Delay in seeking health care from health facilities is a potential risk of prolonged disease spread. Therefore, this study assessed the delay in health-seeking behaviour and implications for yellow fever outcomes in the 2019 outbreak in Nigeria. Furthermore, the study examined the factors associated with delayed yellow fever vaccine uptake. A retrospective study was conducted from January to December 2019 using 137 cases recorded in the WHO database. The data were analysed using descriptive (frequency and percentages) and the Chi-square test. The results were significant at p < 0.05. Results showed a low uptake of yellow fever vaccine (24.1%) among patients and a median total health-seeking delay of 7 [IQR 7, 9] days. The delay was more among the older age ≥40 years (12 [IQR 12, 29]), females (8 [IQR 8, 11], and rural inhabitants 7 [IQR7, 9], particularly in Izzi LGA (9 [IQR 9, 16] than the other subgroups. Patients' location or place of residence was significantly associated with the yellow fever vaccine uptake (p < 0.000*), and delay (p = 0.003*). Conclusively, the low vaccine uptake was due to the delay in health-seeking behaviour. Thus, the healthcare system in Nigeria needs to intensify mass participation in immunisation programmes. Interventions that promote behavioural change towards immunisation are required. Also, health promotion campaigns to educate rural people on desirable health-seeking behaviour are needed.

19.
Vaccine ; 39(13): 1846-1856, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33685778

RESUMEN

Yellow fever (YF) remains a threat to human health in tropical regions of Africa and South America. Live-attenuated YF-17D vaccines have proven to be safe and effective in protecting travellers and populations in endemic regions against YF, despite very rare severe reactions following vaccination - YF vaccine-associated viscerotropic disease (YEL-AVD) and neurological disease (YEL-AND). We describe the generation and selection of a live-attenuated YF-17D vaccine candidate and present its preclinical profile. Initially, 24 YF-17D vaccine candidate sub-strains from the Stamaril® and YF-VAX® lineage were created through transfection of viral genomic RNA into Vero cells cultured in serum-free media to produce seed lots. The clone with the 'optimal' preclinical profile, i.e. the lowest neurovirulence, neurotropism and viscerotropism, and immunogenicity at least comparable with Stamaril and YF-VAX in relevant animal models, was selected as the vaccine candidate and taken forward for assessment at various production stages. The 'optimal' vaccine candidate was obtained from the YF-VAX lineage (hence named vYF-247) and had five nucleotide differences relative to its parent, with only two changes that resulted in amino acid changes at position 480 of the envelope protein (E) (valine to leucine), and position 65 of the non-structural protein 2A (NS2A) (methionine to valine). vYF-247 was less neurovirulent in mice than Stamaril and YF-VAX irrespective of production stage. Its attenuation profile in terms of neurotropism and viscerotropism was similar to YF-VAX in A129 mice, a 'worst case' animal model lacking type-I IFN receptors required to initiate viral clearance. Thus, vYF-247 would not be expected to have higher rates of YEL-AVD or YEL-AND than Stamaril and YF-VAX. In hamsters, vYF-247 was immunogenic and protected against high viremia and death induced by a lethal challenge with the hamster-adapted Jimenez P10 YF virus strain. Our data suggests that vYF-247 would provide robust protection against YF disease in humans, similar to currently marketed YF vaccines.

20.
AJR Am J Roentgenol ; : 1-8, 2021 Mar 11.
Artículo en Inglés | MEDLINE | ID: mdl-33703928

RESUMEN

OBJECTIVE. Yellow fever is a hemorrhagic disease caused by an arbovirus endemic in South America; outbreaks have occurred in recent years. The purpose of this study was to describe abdominal ultrasound findings in patients with severe yellow fever and correlate them with clinical and laboratory data. MATERIALS AND METHODS. A retrospective cohort study was performed between January and April 2018. The subjects were patients admitted to an ICU with polymerase chain reaction-confirmed yellow fever. Bedside sonography was performed within 48 hours of admission. Images were independently analyzed by two board-certified radiologists. Laboratory test samples were collected within 12 hours of image acquisition. Multivariable logistic regression analysis was performed to identify 30-day mortality predictors; p < .05 was considered statistically significant. RESULTS. Forty-six patients (40 [87%] men, six [13%] women; mean age, 47.5 ± 15.2 years) were evaluated with bedside sonography. Laboratory tests showed high serum levels of aspartate aminotransferase (5319 U/L), total bilirubin (6.2 mg/dL), and creati-nine (4.3 mg/dL). Twenty-six (56.5%) patients died within 30 days of admission (median time to death, 5 days [interquartile range, 2-9 days]). The most frequent ultrasound findings were gallbladder wall thickening (80.4%), increased renal cortex echogenicity (71.7%), increased liver parenchyma echogenicity (65.2%), perirenal fluid (52.2%), and ascites (30.4%). Increased renal echogenicity was associated with 30-day mortality (84.6% versus 55.0%; p = .046) and was an independent predictor of this outcome after multivariate analysis (odds ratio, 10.89; p = .048). CONCLUSION. Reproducible abdominal ultrasound findings in patients with severe yellow fever may be associated with severity of disease and prognosis among patients treated in the ICU.

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