Persistence of dengue serotype 2 viral RNA in blood cells of a returned traveler with dengue fever.

Dengue virus (DENV) is one of the most significant vector-borne pathogens worldwide. In this report, we describe clinical features and laboratory detection of dengue in a 45-year-old traveler to Nicaragua on return home to the United States in 2019. Clinical presentation was mild, with rash, headache, and fatigue, with only low-grade transient fever. Infection dynamics were documented by serology and PCR of serially collected body fluids. DENV serotype 2 was detected in whole blood 1 day after symptoms emerged, with viral RNA isolated to the red cell fraction, and remained detectable through day 89. DENV-2 RNA was detected in serum only on day 4, and IgM was undetectable on day 4 but evident by day 13. Viral RNA was also detected in urine. This report of DENV-2 RNA persistence in blood cells but only transient appearance in serum, supports the potential diagnostic value of whole blood over serum for PCR and opportunity of an expanded testing window. Informed testing approaches can improve diagnostic accuracy and inform strategies that preserve individual and public health.

Development of Vaccines against Emerging Mosquito-Vectored Arbovirus Infections.

Among emergent climate-sensitive infectious diseases, some mosquito-vectored arbovirus infections have epidemiological, social, and economic effects. Dengue virus (DENV), West Nile virus (WNV), and Chikungunya virus (CHIKV) disease, previously common only in the tropics, currently pose a major risk to global health and are expected to expand dramatically in the near future if adequate containment measures are not implemented. The lack of safe and effective vaccines is critical as it seems likely that emerging mosquito-vectored arbovirus infections will be con-trolled only when effective and safe vaccines against each of these infections become available. This paper discusses the clinical characteristics of DENV, WNV, and CHIKV infections and the state of development of vaccines against these viruses. An ideal vaccine should be able to evoke with a single administration a prompt activation of B and T cells, adequate concentrations of protecting/neutralizing antibodies, and the creation of a strong immune memory capable of triggering an effective secondary antibody response after new infection with a wild-type and/or mutated infectious agent. Moreover, the vaccine should be well tolerated, safe, easily administrated, cost-effective, and widely available throughout the world. However, the development of vaccines against emerging mosquito-vectored arbovirus diseases is far from being satisfactory, and it seems likely that it will take many years before effective and safe vaccines for all these infections are made available worldwide.

Genus Culex Linnaeus, 1758 (Diptera: Culicidae) as an Important Potential Arbovirus Vector in Brazil: An Integrative Review.

The genus Culex has 817 species subdivided into 28 subgenera. It has a cosmopolitan distribution, being most abundant in countries with a tropical climate. Understanding the ecology and diversity of viruses circulating in the species of this genus is important for understanding their role as arbovirus vectors in Brazil. To conduct an integrative review to identify the importance of the Culex genus as arbovirus vectors in Brazil. A search was carried out for scientific papers in the PubMed, BVSalud, Patuá-IEC and International Catalogue of Arboviruses: including certain other viruses of vertebrates databases. 36 publications describing arbovirus detections in Culex mosquitoes collected in the field in Brazil were evaluated. A total of 42 arbovirus species were detected, as well as studies analyzing the vector competence of C. quinquefasciatus for the transmission of four different arboviruses. The study of the Culex genus and its role as a vector of arboviruses in Brazil is essential for understanding transmission cycles, with the main aim of reducing cases of human infection. Thus, entomovirological surveillance guides the implementation of actions to detect circulating arboviruses among vectors to anticipate measures aimed at preventing or reducing the risk of arbovirus outbreaks in the country.

Diagnosis of Dengue Virus Infections Imported to Hungary and Phylogenetic Analysis of Virus Isolates.

BACKGROUND: Dengue virus is one of the most important arbovirus infections of public health concern. Between 2017 and June 2022, 75 imported dengue infections were confirmed by laboratory diagnostic methods in Hungary. Our study aimed to isolate the imported Dengue strains and characterize them by whole-genome sequencing. METHODS: Laboratory diagnosis of imported infections was carried out using both serological and molecular methods. Virus isolation was attempted on Vero E6 cell lines. An in-house amplicon-based whole-genome sequencing method was applied for the detailed molecular characterization of the isolated virus strains. RESULTS: From 75 confirmed Dengue infected patients, 68 samples were used for virus isolation. Isolation and whole-genome sequencing were successful in the case of eleven specimens. Isolated strains belonged to Dengue-1,-2,-3 serotypes. DISCUSSION: The isolated strains corresponded to the circulating genotypes of the visited geographic area, and some of the genotypes were linked with more severe DENV cases in the literature. We found that multiple factors, including viral load, specimen type, and patient antibody status, influence the isolation efficacy. CONCLUSIONS: Analysis of imported DENV strains can help estimate the outcomes of a possible local DENV transmission in Hungary, a threat from the near future.

Extra-articular Manifestations of Chikungunya

ABSTRACT Chikungunya fever (CHIK) is a neglected tropical disease associated with chronic arthritis. CHIK is usually a self-limiting condition; however, extra-articular manifestations present as atypical illness in a minority of patients. These atypical features may mimic other conditions and potentially distract physicians from the true diagnosis. This review analyzes the evidence of many unusual extra-articular manifestations reported in cases of CHIK. Depending on the affected system, these unusual manifestations include encephalitis, myocarditis, acute interstitial nephritis, cutaneous manifestations, acute anterior uveitis, abdominal pain, and depression. In addition, coinfections and comorbidities may cause atypical illness and obscure the diagnosis. Further studies are required to clarify the pathophysiology and natural history of CHIK, as it remains a burdening condition. Exploring its atypical symptoms may be the missing scientific piece of this puzzle.

Conocimientos y medidas preventivas sobre arbovirosis en estudiantes universitarios de una zona endémica del Perú / Knowledge and preventive measures on arbovirus infections among university students in an endemic area of Peru / Conhecimento e medidas preventivas sobre arboviroses em estudantes universitários de uma área endêmica do Peru

RESUMEN Introducción: Las arbovirosis constituyen un grave problema sanitario en el Perú. Un mayor conocimiento y participación de la población en actividades preventivas puede minimizar su impacto. Objetivo: Evaluar el nivel de conocimientos y su relación con las medidas preventivas sobre arbovirosis en estudiantes universitarios de una zona endémica del Perú, septiembre a noviembre de 2020. Método: Se realizó un estudio observacional, transversal, correlacional y con diseño no experimental. La población estuvo conformada por 325 estudiantes de tecnología médica y la muestra por 176 estudiantes de ambos sexos. El nivel de conocimiento se categorizó en deficiente, regular y alto. Mientras que las medidas preventivas se clasificaron en adecuadas e inadecuadas. El cuestionario contenía 23 preguntas de opción múltiple, validadas por juicio de expertos. Resultados: El 69,9 % de los estudiantes presentó un nivel de conocimientos regular, observándose medidas preventivas inadecuadas en el 44,3 %. Un 92,0 % de encuestados consideró que las arbovirosis son enfermedades graves, pero solo 10,2 % reconoció el signo de alarma del zika. Las principales medidas preventivas fueron: la fumigación (50,6 %) y el uso de repelentes (49,6 %). Además, el 92,6 % de estudiantes consideró importante eliminar los criaderos de mosquitos para evitar la propagación de los arbovirus. Sin embargo, solo el 51,1 % revisó la presencia de criaderos y limpió diaria e interdiariamente su domicilio (43,8 %). Conclusiones: El nivel de conocimientos fue regular y se relacionó con medidas preventivas inadecuadas como no revisar frecuentemente la presencia de criaderos de mosquitos ni realizar limpieza en las viviendas.

ABSTRACT Introduction: Arbovirus infections are a serious health problem in Peru. Higher population awareness and their participation in preventive activities can minimize their impact. Objective: Assessment on the level of knowledge and its relationship with preventive measures concerning arbovirus infections in university students in an endemic area of Peru, September to November 2020. Method: An observational, cross-sectional, correlational and non-experimental design study was carried out. The population consisted of 325 medical technology students and the sample consisted of 176 students of both sexes. The level of knowledge was categorized as deficient, regular and high. Preventive measures were classified as adequate and inadequate. The questionnaire contained 23 multiple-choice questions, validated by expert judgment. Results: The knowledge level in 69.9% of the students was fair, and inadequate preventive measures were observed in 44.3%. The 92.0% of surveyed personnel considered the arbovirus infection as a serious disease, but only 10.2% recognized the warning sign of zika. The main preventive measures were: fumigation (50.6%) and the use of repellents (49.6%). In addition, 92.6% of students considered as an important action the act to eliminate mosquito breeding sites in order to prevent the spread of infection. However, only 51.1% checked for the presence of breeding sites and cleaned their homes on a daily and inter-daily basis (43.8%). Conclusions: The level of knowledge was regular and was related to inadequate preventive measures such as not frequently checking for the presence of mosquito breeding sites and not cleaning houses.

RESUMO Introdução: As arboviroses constituem um grave problema de saúde no Peru. Maior conhecimento e participação da população em atividades preventivas podem minimizar seu impacto. Objetivo: avaliar o nível de conhecimento e sua relação com medidas preventivas sobre arboviroses em estudantes universitários em uma área endêmica do Peru, de setembro a novembro de 2020. Método: Estudo observacional, transversal, correlacional com desenho não experimental foi realizado. A população foi composta por 325 estudantes de tecnologia médica e a amostra por 176 estudantes de ambos os sexos. O nível de conhecimento foi categorizado em deficiente, regular e alto. Enquanto as medidas preventivas foram classificadas como adequadas e inadequadas. O questionário continha 23 questões de múltipla escolha, validadas por julgamento de especialistas. Resultados: 69,9% dos alunos apresentaram nível regular de conhecimento, observando medidas preventivas inadequadas em 44,3%. 92,0% dos pesquisados consideraram que as arboviroses são doenças graves, mas apenas 10,2% reconheceram o sinal de alerta do Zika. As principais medidas preventivas foram: fumigação (50,6%) e uso de repelentes (49,6%). Além disso, 92,6% dos alunos consideraram importante eliminar os criadouros do mosquito para evitar a propagação de arboviroses. No entanto, apenas 51,1% verificaram a presença de criadouros e limparam suas casas diariamente e em dias alternados (43,8%). Conclusões: O nível de conhecimento foi regular e relacionado a medidas preventivas inadequadas, como não verificar com frequência a presença de criadouros do mosquito ou limpeza das residências.

Systemic Manifestations, Tooth Eruption and Enamel Defects in Children with Congenital Zika Virus Syndrome: 36-Month Follow-up Case Series

Abstract Objective: To describe systemic manifestations, the characteristics related to tooth eruption, and the occurrence of enamel defects in children with Congenital Zika Virus Syndrome (CZS). Material and Methods: Prospective case series based on nine children with confirmed CZS diagnosis assisted at a reference center in a municipality in the Northeast Region of Brazil. Through a structured interview directed to mothers, information related to prenatal, delivery, and postpartum periods was collected. Tooth eruption was monitored through clinical examinations for 36 months. The modified developmental defect of enamel index (DDE) was used to identify opacities and hypoplasia. Data were presented using descriptive statistics. Results: A high proportion (77.8%) had microcephaly, and 55.5% had low birth weight. Musculoskeletal disorders, swallowing difficulty, and self-injury practices were present in all children. Among the systemic findings, visual impairment (77.8%) and seizures (77.8%) were widely reported. Concerning disorders related to the stomatognathic system, bruxism (66.7%) and difficulty in sucking (33.3%) were present. For most children (77.8%), the deciduous right lower central incisor was the first tooth to erupt (minimum 8 months and maximum 17 months). Enamel defects were diagnosed in only two children (22.2%). Conclusion: A wide range of systemic manifestations was observed in children with CZS, including visual impairment and musculoskeletal disorders. Delayed eruption of the first deciduous tooth was also observed. Enamel defects were present in a small proportion of children.

Conhecimento de futuros enfermeiros e médicos sobre dengue, zika e chikungunya / Conocimiento de futuros enfermeros y médicos sobre dengue, zika y chikungunya / Future nurses and doctors' knowledge of dengue, zika and chikungunya

RESUMO Objetivo comparar o conhecimento autorreferido de formandos de medicina e enfermagem em relação à dengue, zika e chikungunya. Método estudo transversal, exploratório e de abordagem quantitativa, realizado em uma universidade pública com 41 formandos dos cursos de enfermagem e medicina. Os dados foram coletados por meio de um questionário autorrespondido e analisados por meio de um modelo linear generalizado com distribuição binomial com função de ligação identidade. Protocolo aprovado pelo Comitê de Ética em Pesquisa. Resultados os graduandos de medicina apresentaram as maiores médias de acertos; porém, somente as variáveis referentes ao exame clínico e à evolução e complicações apresentaram diferença estatisticamente significativa entre os cursos. Conclusão esse estudo reforça a importância da formação de enfermeiros e médicos, para que estejam capacitados e preparados para assistir à população, desde o desenvolvimento de ações preventivas até a reabilitação de usuários acometidos por uma arbovirose.

RESUMEN Objetivo comparar los conocimientos autoinformados de egresados de medicina y enfermería en relación con el dengue, el zika y el chikungunya. Método estudio transversal, exploratorio con enfoque cuantitativo, realizado en una universidad pública con 41 egresados de los cursos de enfermería y medicina. Los datos se recolectaron mediante un cuestionario autoadministrado y se analizaron a través de un modelo lineal generalizado con distribución binomial con función de vínculo de identidad. Protocolo aprobado por el Comité de Ética en Investigación. Resultados los estudiantes de medicina tuvieron el promedio más alto de respuestas correctas; sin embargo, solo las variables relacionadas con el examen clínico y la evolución y las complicaciones mostraron una diferencia estadísticamente significativa entre los cursos. Conclusión este estudio refuerza la importancia de formar enfermeros y médicos, para que estén capacitados y preparados para atender a la población, desde el desarrollo de acciones preventivas hasta la rehabilitación de usuarios afectados por un arbovirus.

ABSTRACT Objective to compare medical and nursing graduates' self-reported knowledge of dengue, zika and chikungunya. Method this quantitative, exploratory, cross-sectional study was conducted at a public university with 41 nursing and medical graduates. Data were collected using a self-answered questionnaire and analyzed using a generalized linear model with binomial distribution and identity link function. The protocol was approved by the research ethics committee. Results on average, medical students returned more correct answers; however, statistically significant differences were found between the courses only on variables relating to clinical examination and evolution and complications. Conclusion this study underlines the importance of training nurses and doctors, so that they are able and prepared to provide care ranging from preventive actions through to rehabilitation of users affected by an arbovirus.

Conhecimento de futuros enfermeiros e médicos sobre dengue, zika e chikungunya / Future nurses and doctors' knowledge of dengue, zika and chikungunya / Conocimiento de futuros enfermeros y médicos sobre dengue, zika y chikungunya

Objetivo: comparar o conhecimento autorreferido de formandos de medicina e enfermagem em relação à dengue, zika e chikungunya. Método: estudo transversal, exploratório e de abordagem quantitativa, realizado em uma universidade pública com 41 formandos dos cursos de enfermagem e medicina. Os dados foram coletados por meio de um questionário autorrespondido e analisados por meio de um modelo linear generalizado com distribuição binomial com função de ligação identidade. Protocolo aprovado pelo Comitê de Ética em Pesquisa. Resultados: os graduandos de medicina apresentaram as maiores médias de acertos; porém, somente as variáveis referentes ao exame clínico e à evolução e complicações apresentaram diferença estatisticamente significativa entre os cursos. Conclusão: esse estudo reforça a importância da formação de enfermeiros e médicos, para que estejam capacitados e preparados para assistir à população, desde o desenvolvimento de ações preventivas até a reabilitação de usuários acometidos por uma arbovirose.

Objective: to compare medical and nursing graduates' self-reported knowledge of dengue, zika and chikungunya. Method: this quantitative, exploratory, cross-sectional study was conducted at a public university with 41 nursing and medical graduates. Data were collected using a self-answered questionnaire and analyzed using a generalized linear model with binomial distribution and identity link function. The protocol was approved by the research ethics committee. Results: on average, medical students returned more correct answers; however, statistically significant differences were found between the courses only on variables relating to clinical examination and evolution and complications. Conclusion: this study underlines the importance of training nurses and doctors, so that they are able and prepared to provide care ranging from preventive actions through to rehabilitation of users affected by an arbovirus.

Objetivo: comparar los conocimientos autoinformados de egresados de medicina y enfermería en relación con el dengue, el zika y el chikungunya. Método: estudio transversal, exploratorio con enfoque cuantitativo, realizado en una universidad pública con 41 egresados de los cursos de enfermería y medicina. Los datos se recolectaron mediante un cuestionario autoadministrado y se analizaron a través de un modelo lineal generalizado con distribución binomial con función de vínculo de identidad. Protocolo aprobado por el Comité de Ética en Investigación. Resultados: los estudiantes de medicina tuvieron el promedio más alto de respuestas correctas; sin embargo, solo las variables relacionadas con el examen clínico y la evolución y las complicaciones mostraron una diferencia estadísticamente significativa entre los cursos. Conclusión: este estudio refuerza la importancia de formar enfermeros y médicos, para que estén capacitados y preparados para atender a la población, desde el desarrollo de acciones preventivas hasta la rehabilitación de usuarios afectados por un arbovirus.

Chikungunya Virus Infection Outcome: A Systematic Review of Host Genetics.

Background: Chikungunya virus (CHIKV) is a global concern, inducing chikungunya fever and trigging an arthritogenic chronic phase beyond some severe forms. Outcomes of CHIKV infections in humans are dependent on genetic variations. Here, a systematic review was performed to show evidence of genetic variations on infection outcomes of patients. Methods: Searches were performed in Scopus, SciELO, MEDLINE/PubMed, Web of Science, OneFile (GALE), Periódicos CAPES and ScienceDirect Journals databases. The PICOS approach was used to assess the eligibility of records. A meta-analysis was also conducted to show an association between described alleles/genes and CHIKV infection outcome. Results: Reviews of genetic variants were conducted on genes: CD 209, OAS1, OAS2, OAS3, MIF, TLR-3, TLR-7, TLR-8, MYD-88, KIR, HLA-B; HLA-C; DRB1 and DQB1. Studies were performed on Gabon, Singapore, and India, including Indians, Malay, Gabonese and Chinese ethnicities and published between 2009-2017. The meta-analysis was performed with DRB1 *01; *03; *04; *07; *10; *11; *13; *14 and *15 and DQB1 *02; *03; *05 and *06 alleles with Indian population sample. Sampling power was >80% and a significant positive association between DRB1*14 and CHIKV infection was found (OR = 1.67, 95% CI = 1.04-2.67; p = .03). Conclusion: Majority of the studies were conducted in India. Meta-analysis suggests that DRB1*14 is related to the susceptibility of symptomatic CHIKV infection in Indian population. The literature about CHIKV infection and genetic variations is scarce. The precise role of genetic variation in CHIKV is not clear yet. Further studies are necessary to provide more concrete evidences.

Incidence and spatial distribution of cases of dengue, from 2010 to 2019: an ecological study

ABSTRACT BACKGROUND: Dengue is an arbovirus that has caused serious problem in Brazil, putting the public health system under severe stress. Understanding its incidence and spatial distribution is essential for disease control and prevention. OBJECTIVE: To perform an analysis on dengue incidence and spatial distribution in a medium-sized, cool-climate and high-altitude city. DESIGN AND SETTING: Ecological study carried out in a public institution in the city of Garanhuns, Pernambuco, Brazil. METHODS: Secondary data provided by specific agencies in each area were used for spatial analysis and elaboration of kernel maps, incidence calculations, correlations and percentages of dengue occurrence. The Geocentric Reference System for the Americas (Sistema de Referência Geocêntrico para as Américas, SIRGAS), 2000, was the software of choice. RESULTS: The incidence rates were calculated per 100,000 inhabitants. Between 2010 and 2019, there were 6,504 cases and the incidence was 474.92. From 2010 to 2014, the incidence was 161.46 for a total of 1,069 cases. The highest incidence occurred in the period from 2015 to 2019: out of a total of 5,435 cases, the incidence was 748.65, representing an increase of 485.97%. Population density and the interaction between two climatic factors, i.e. atypical temperature above 31 °C and relative humidity above 31.4%, contributed to the peak incidence of dengue, although these variables were not statistically significant (P > 0.05). CONCLUSION: The dengue incidence levels and spatial distribution reflected virus and vector adjustment to the local climate. However, there was no correlation between climatic factors and occurrences of dengue in this city.

Caracterización de pacientes con sospecha de arbovirosis atendidos en un policlínico de Jiguaní, Granma / Characterization of patients with suspected arbovirus infection cared for at a polyclinic in Jiguaní, Granma

Introducción: Las enfermedades producidas por arbovirus son un problema grave a nivel mundial. Objetivo: Caracterizar los pacientes estudiados por sospecha de arbovirosis en una institución de salud. Métodos: Se realizó un estudio observacional, descriptivo y transversal en el policlínico Edor de los Reyes Martínez Áreas del municipio Jiguaní, provincia Granma, en el periodo comprendido entre el 1 de enero y el 31 de diciembre de 2019. Se trabajó con una muestra de 2947 personas y se estudiaron las siguientes variables: edad, sexo, consejos populares, forma de identificación de signos/síntomas, diagnóstico inicial y positividad a dengue. Resultados: El 40,07 por ciento de los casos estudiados pertenece al consejo popular Jiguaní Norte. Fueron pacientes femeninas 1590 (53,95 por ciento). El rango de edad predominante fue 41-60 años (n = 1222; 41,47 por ciento). En 1908 (64,74 por ciento) pacientes la identificación de signos y síntomas sugerentes de arbovirosis fue mediante las pesquisas. El 98,88 por ciento de los pacientes (n = 2914) fue diagnosticado inicialmente con síndrome febril inespecífico. La única arbovirosis identificada fue el dengue, el que se encontró en 637 pacientes. Octubre fue el mes con mayor número de pacientes estudiados (n = 1063; 36,07 por ciento). Conclusiones: La mayoría de los casos pertenecía al sexo femenino y a la zona urbanizada del municipio. El consejo popular urbano Jiguaní Norte fue el que más casos positivos a dengue aportó(AU)

Introduction: Arbovirus infections are a serious global health problem. Objective: Characterize the patients studied for suspected arbovirus infection at a health institution. Methods: A cross-sectional observational descriptive study was conducted at Edor de los Reyes Martínez Arias polyclinic in the municipality of Jiguaní, province of Granma, from 1 January to 31 December 2019. The study sample was 2947 people, and the variables examined were age, sex, people's council, form of sign / symptom identification, initial diagnosis and positivity for dengue. Results: Of the cases studied, 40.07 percent were from the people's council of Jiguaní Norte. 1590 patients were female (53.95 percent). The prevailing age group was 41-60 years (n = 1222; 41.47 percent). In 1908 patients (64.74 percent) signs and symptoms suggesting arbovirus infection were identified through screening. 98.88 percent of the patients (n = 2914) were initially diagnosed with unspecific febrile syndrome. The only arbovirus infection identified was dengue, which was detected in 637 patients. October was the month when the highest number of patients were studied (n = 1063; 36.07 percent). Conclusions: Most cases were female and from urbanized areas in the municipality. Jiguaní Norte urban people's council contributed the most dengue positive cases(AU)

Serological cross-reactivity using a SARS-CoV-2 ELISA test in acute Zika virus infection, Colombia.

OBJECTIVES: We investigated seroreactivity by using a commercial SARS-CoV-2 ELISA test in samples collected from different groups of individuals, including patients diagnosed to have Dengue, Zika, and Chikungunya infection between 2015 and 2019, from an endemic area in the Caribbean Colombian region. METHODS: A total of 127 sera samples obtained from six different groups of individuals were included in this study: Group A: patients with confirmed SARS-CoV-2 infection; Group B: patients with symptoms suggestive of COVID-19 or asymptomatic contacts with confirmed patients; Group C: patients with acute or recent dengue virus infection; Group D: patients with acute Zika virus infection; Group E: patients with previous Chikungunya virus infection; and Group F: individuals with exposure to spotted fever group rickettsiae. RESULTS: Overall, group A, group B, and group D showed seroreactivity to SARS-CoV-2 in 92%, 75%, and 26% of samples, respectively; furthermore, group C, group E, and group F showed 100% seronegativity. CONCLUSIONS: We found 26% of serological cross-reactivity in patients with acute Zika virus infection by using a commercial SARS-CoV-2 ELISA test. Further studies are needed to evaluate whether serological cross-reaction is maintained with time in nonacute patients with previous exposure to the Zika virus and its effect in SARS-CoV-2 serosurveys in endemic areas for this arbovirus.

Caracterización clinicoepidemiológica de pacientes con dengue ingresados en el Instituto de Medicina Tropical Pedro Kourí / Clinical epidemiological characterization of patients with dengue admitted to Pedro Kourí Tropical Medicine Institute

Introducción: El dengue es una infección viral endémica reemergente de notable preponderancia por su morbilidad y mortalidad, cuya incidencia se ha multiplicado en las últimos tiempos a nivel internacional. Objetivos: Caracterizar a pacientes con dengue según la clasificación revisada de la Organización Mundial de la Salud y determinar la correspondencia entre esta y la clasificación tradicional respecto a la gravedad de los casos. Métodos: Se realizó un estudio descriptivo y transversal en el Instituto de Medicina Tropical Pedro Kourí de La Habana durante el 2012, en el que se revisaron 247 historias clínicas seleccionadas por muestreo aleatorio estratificado. Resultados: En la casuística predominaron el dengue con signos de alarma, el grupo etario de 40-59 años, el sexo femenino y el síndrome de choque por dengue como principal forma clínica de gravedad. La fiebre estuvo presente en todos los afectados; también sobresalieron la cefalea, la astenia, las artromialgias, la exantema y el dolor retroocular. La leucopenia y la trombocitopenia constituyeron hallazgos muy frecuentes, al igual que la citólisis hepática; en tanto, las manifestaciones digestivas y hemorrágicas, entre otras, se asociaron significativamente con el desarrollo de dengue grave. Conclusiones: Se evidenció que utilizando la clasificación tradicional se hubiesen dejado de identificar y tratar adecuadamente a pacientes con dengue grave y dengue con signos de alarma, al catalogarse la mayoría de estos como fiebre del dengue, subestimando así la gravedad clínica de dichos casos.

Introduction: Dengue is a viral endemic reemerging infection of remarkable preponderance for its morbidity and mortality whose incidence has multiplied in the last times at international level. Objectives: To characterize patients with dengue according to the classification reviewed by the Health World Organization and to determine the correspondence between this and the traditional classification regarding the seriousness of the cases. Methods: A descriptive and cross-sectional study was carried out at Pedro Kourí Tropical Medicine Institute in Havana during 2012, in which 247 medical records were reviewed selected by stratified random sampling. Results: In the case material there was a prevalence of dengue with alarm signs, 40-59 age group, female sex and the shock syndrome due to dengue as the main clinic form of seriousness. The fever was present in all those affected; migraine, asthenia, artromialgias, exanthema and retroocular pain were also outstanding. The leukopenia and thrombocytopenia constituted very frequent findings, the same as hepatic cytolysis; as long as, the digestive and hemorrhagic manifestations, among others, were significantly associated with the development of serious dengue. Conclusions: It was evidenced that using the traditional classification the identification and appropriate treatment to patients with serious dengue and dengue with alarm signs would not be possible, when being classified most of these as fever of the dengue, underestimating this way the clinical seriousness of these cases.

Effect of Oral Infection of Mayaro Virus on Fitness Correlates and Expression of Immune Related Genes in Aedes aegypti.

Mayaro virus is a mosquito-borne Alphavirus endemic to forests of tropical South America with a sylvatic cycle involving non-human primates and Haemagogus mosquitoes. Human infection with Mayaro virus causes a febrile illness and long-lasting arthralgia and cases are often associated with exposure to tropical forest habitats. Human movement between tropical forest habitats and urban settings may allow for imported cases and subsequent local transmission by domestic mosquito Aedes aegypti. The relative importance of Ae. aegypti as a vector of Mayaro virus may depend on the pathogenic effects of the virus on fitness correlates, especially those entomological parameters that relate to vectorial capacity. We performed mosquito infection studies and compared adult survival and fecundity of females from Brazilian and Floridian populations of Ae. aegypti following oral ingestion of uninfectious (control) and Mayaro virus infectious blood. Mayaro virus infected and refractory mosquitoes had similar or 30-50% lower fecundity than control (unexposed) mosquitoes, suggesting a reproductive cost to mounting an immune response or phenotypic expression of refractoriness. Survival of adult female mosquitoes and targeted gene expression in the Toll and IMD pathways were not altered by Mayaro virus infection. Adult lifespan and fecundity estimates were independent of measured viral titer in the bodies of mosquitoes. The lack of adverse effects of infection status on female survival suggests that Mayaro virus will not alter vectorial capacity mediated by changes in this parameter.

Complicaciones oculares asociadas a la fiebre por dengue / Ophthalmic complications associated to dengue fever

RESUMEN La infección por el virus del dengue va en aumento en las regiones tropicales de Asia, África y América. Se estima que se producen de 50 a 100 millones de casos de esta enfermedad al año. En los últimos tiempos han aumentado los reportes de manifestaciones oculares en estos pacientes, las cuales ocurren en un rango de 5 a 7 días posteriores al inicio de los síntomas, aunque también pueden ocurrir más tarde, y generalmente existe buen pronóstico visual. Se realiza una revisión bibliográfica con el objetivo de ampliar el conocimiento sobre un tema poco tratado en nuestro medio. Se consultaron fundamentalmente artículos científicos de revistas, publicados en las bases de datos PubMED y Cochrane, así como textos básicos que abordan este tema en los últimos 5 años, a través de Google académico como motor de búsqueda. Se constató que se han reportado manifestaciones oculares en pacientes con dengue que van desde hallazgos en el segmento anterior sin afectación visual, hasta cuadros más intensos que interesan las estructuras del polo posterior del ojo. La fisiopatología de estos hallazgos aún se encuentra en estudio y no existe consenso para su tratamiento. A pesar de que el pronóstico visual de estas alteraciones es bueno, se reportan casos donde no es así y se precisa mayor comprensión sobre la fisiopatología de estas para un abordaje terapéutico más adecuado en cada caso(AU)

ABSTRACT Infection by dengue virus is on the increase in tropical regions of Asia, Africa and America. It has been estimated that 50 to 100 million cases of this disease occur every year. Recent years have witnessed a rise in the number of reports of ocular manifestations in dengue patients. These manifestations appear 5 to 7 days after symptom onset, though they could also occur later, and the visual prognosis is generally good. A bibliographic review was conducted with the purpose of broadening knowledge about a topic not commonly dealt with in our environment. The search was mainly aimed at scientific papers from journals, published in the databases PubMed and Cochrane, as well as basic texts addressing the study topic in the last 5 years, using the search engine Google Scholar. Ocular manifestations were found to have been reported in dengue patients. These range from findings in the anterior segment without any visual alteration to more intense episodes affecting the structures of the posterior pole of the eye. The physiopathology of these findings is still being studied, and there is no consensus about its treatment. Despite the good visual prognosis of these alterations, cases have been reported of a different outcome. Therefore, a better understanding is required of their physiopathology to achieve a more appropriate therapy for each case(AU)

SARS-COV-2 AND ARBOVIRUS INFECTIONS: PROTOCOL FOR A RAPID LIVING SYSTEMATIC REVIEW

Context and objective: While cases of COVID-19 disease increase daily worldwide, outbreaks of arboviral infections have affected health systems of countries in tropical regions. The outcomes for patients and health systems of a possible syndemic are not clarified yet. Thus, we aim to systematically review the literature searching for evidence that describes the clinical presentation, severity and prognostic of SARS-CoV-2 and Arboviral coinfection. Design and setting: Protocol for a rapid living systematic review, that will follow the Cochrane Handbook for Systematic Reviews recommendations. We will include prospective and retrospective cohort, case-control studies and case series of patients with confirmed diagnosis of SARS-CoV-2 and Arboviral infection. We will perform the search strategy with no language restrictions on Medline via PubMed, Embase via Elsevier, Cochrane Library - Cochrane Central Register of Controlled Trials (CENTRAL), Portal Regional BVS - LILACS, Scopus and WebOfScience to identify published, ongoing, and unpublished studies. The selection and extraction will be performed by two authors. We will perform the critical appraisal of included studies with the Newcastle-Ottawa Scale and the certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).    

Health-Related Quality of Life after Dengue Fever, Morelos, Mexico, 2016-2017.

We adapted the EQ-5D-3L questionnaire and visual analog scale to assess health-related quality of life (HRQOL) and persistent symptoms in 79 patients with laboratory-confirmed dengue in Morelos, Mexico. The lowest HRQOLs were 0.53 and 38.1 (febrile phase). Patients recovered baseline HRQOL in ≈2 months.

Evaluación de índices entomológicos mediante herramientas electrónicas en Villavicencio, Meta, Colombia / Evaluation of entomological indices with electronic tools in Villavicencio, Meta, Colombia

Objetivo: Determinar la eficacia de dos herramientas electrónicas en el levantamiento de índices aédicos en la ciudad Villavicencio. Métodos: Se realizó un estudio de tipo observacional, analítico en dos barrios de la ciudad Villavicencio: Quintas de San Fernando y Cedritos. El formato de levantamiento de índices aédicos de la secretaría de salud fue diseñado en dos medios electrónicos. La eficacia fue determinada mediante datos efectivos recogidos y tiempo de entrega. Se calcularon índices aédicos, Breteau, vivienda y pupas. Se realizó encuesta para determinar actitudes frente a arbovirosis. Se realizó estadística descriptiva, pruebas de chi cuadrado y t-Student (p< 0,05). Resultados: Se evaluaron 67 predios en dos barrios. El índice de datos efectivos fue mejor en donde el acceso a internet era permanente (100 por ciento vs. 23,9 por ciento); el tiempo de entrega también se afectó por esta conexión. Se encontraron diferencias significativas en el número de viviendas positivas para Aedes aegypti entre los dos barrios (p= 0,0052); y para el número de tanques bajos positivos (p= 0,0123). De los encuestados, el 16,4 por ciento (IC95 por ciento 8,9 por ciento-27,5 por ciento) sabía que la transmisión fue por picadura de Ae. aegypti. Para el 79,1 por ciento, cada familia fue responsable de eliminar criaderos. Conclusiones: El uso de herramientas electrónicas permite acelerar el flujo de la información y crear un sistema eficaz, de fácil acceso y seguridad que podría implementarse permanentemente en la vigilancia entomológica y de salud pública(AU)

Objective: Determine the effectiveness of two electronic tools for the evaluation of aedic indices in the city of Villavicencio. Methods: An observational analytic study was conducted in two districts in the city of Villavicencio: Quintas de San Fernando and Cedritos. The form designed by the Ministry of Health to evaluate aedic indices was digitalized into two electronic media. Efficacy was determined on the basis of effective data collected and delivery time. An estimation was made of aedic indices, Breteau, household and pupae. A survey was conducted to determine attitudes to arbovirus infections. Use was made of descriptive statistics, chi-squared tests and Student's t-test (p< 0.05). Results: Sixty-seven households were evaluated in two districts. The effective data index was better in areas where access to the Internet was permanent (100 percent vs. 23.9 percent). Delivery time was also affected by Internet connection. Significant differences were found between the two districts in the number of positive households for Aedes aegypti (p= 0.0052), as well as in the number of positive ground water tanks (p= 0.0123). Of the respondents, 16.4 percent (95 percent CI, 8.9 percent-27.5 percent) were aware that transmission had been by the bite of Ae. aegypti mosquitoes. For 79.1 percent each family was responsible for eliminating the breeding sites. Conclusions: Use of electronic tools speeds up the flow of information and creates an effective, easily-accessible and safe system which could be permanently implemented for entomological and public health surveillance(AU)

Emerging Viral Infections Causing Anterior Uveitis.

PURPOSE: To review the systemic and ocular manifestations of specific emergent viral infectious diseases relevant to the ophthalmologist with particular emphasis on anterior uveitis Methods: Review of literature. RESULTS: Arboviral diseases are among the most important emergent and resurgent human infections, occurring mostly in tropical and subtropical zones, but appearing in virtually all regions of the world as a result of climate change, travel, and globalization. Arboviral infections are transmitted to humans by the bite of hematophagous arthropods, mainly mosquitoes. Systemic disease may range from asymptomatic to life-threatening. A wide variety of ocular manifestations, including uveitis, has been reported in association with these emerging viral diseases. Numerous viruses other than arboviruses also have been recently recognized as a potential cause of uveitis. CONCLUSIONS: Proper clinical diagnosis of any emerging infectious disease is based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular involvement. The diagnosis is usually confirmed by detection of virus-specific DNA or antivirus antibodies in serum.