Dengue, chikungunya and zika arbovirus infections in Caribbean children.

PURPOSE OF REVIEW: Dengue, chikungunya and zika have caused significant epidemics in the Caribbean in recent years. This review highlights their impact in Caribbean children. RECENT FINDINGS: Dengue has been increasingly intense and severe, seroprevalence is 80-100% in the Caribbean, children have increased attributable morbidity and mortality. Severe dengue, especially dengue with haemorrhage was significantly associated with haemoglobin SC disease and multiple organ-systems involved. These included the gastrointestinal and haematologic systems with extremely high lactate dehydrogenases and creatinine phosphokinases and severely abnormal bleeding indices. Despite appropriate interventions, mortality was highest within the first 48 h of admission. Chikungunya, a togavirus, affected 80% of some Caribbean populations. Paediatric presentations included high fever, skin, joint and neurological manifestations. Children less than 5 years of age had the highest morbidity and mortality. This maiden chikungunya epidemic was explosive and overwhelmed public health systems. Zika, another flavivirus, has a seroprevalence of 15% in pregnancy, so the Caribbean remains susceptible. Paediatric complications include pregnancy losses, stillbirths, Congenital Zika syndrome, Guillain-Barre syndrome, acute disseminated encephalomyelitis and transverse myelitis. Neurodevelopment stimulation programs for zika-exposed infants have been effective in improving language and positive behaviour scores. SUMMARY: Caribbean children remain at risk for dengue, chikungunya and zika, with high attributable morbidity and mortality.

Neonatal Outcomes From Arboviruses in the Perinatal Period: A State-of-the-Art Review.

Since the 2016 Zika outbreak and the understanding of the teratogenic effect of this infection, there has been a newfound interest in arbovirus infections and their effects on pregnancy, resulting in numerous publications in the last 5 years. However, limited literature focuses on arbovirus infection in different stages of pregnancy and their effect on the neonate. There is currently no consensus management of perinatal acquisition of arboviruses, and current evidence is largely anecdotal observational reports. Teratogens can have different effects on the developing fetus depending on the time of infection, so infections during pregnancy should be analyzed by trimester. A better understanding of arbovirus infection in the perinatal period is required to assist obstetric, neonatal, and pediatric clinicians in making decisions about the management of mother and neonate. Our objective was to assess the evidence of adverse neonatal outcomes for several arboviral infections when contracted during the perinatal period to guide clinicians in managing these patients. There are 8 arboviruses for which neonatal outcomes from maternal acquisition in the perinatal period have been reported, with the most data for dengue and Chikungunya virus infections. The evidence reviewed in this article supports the adoption of preventive strategies to avoid ticks and mosquitoes close to the date of delivery. For the other arbovirus infections, further community-based cohort studies during outbreaks are required to evaluate whether these infections have a similar teratogenic impact.

SARS-CoV-2 and arbovirus infection: a rapid systematic review

ABSTRACT BACKGROUND: The numbers of cases of arboviral diseases have increased in tropical and subtropical regions while the coronavirus disease (COVID-19) pandemic overwhelms healthcare systems worldwide. The clinical manifestations of arboviral diseases, especially dengue fever, can be very similar to COVID-19, and misdiagnoses are still a reality. In the meantime, outcomes for patients and healthcare systems in situations of possible syndemic have not yet been clarified. OBJECTIVE: We set out to conduct a systematic review to understand and summarize the evidence relating to clinical manifestations, disease severity and prognoses among patients coinfected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and arboviruses. METHODS: We conducted a rapid systematic review with meta-analysis, on prospective and retrospective cohorts, case-control studies and case series of patients with confirmed diagnoses of SARS-CoV-2 and arboviral infection. We followed the Cochrane Handbook recommendations. We searched EMBASE, MEDLINE, Cochrane Library, LILACS, Scopus and Web of Science to identify published, ongoing and unpublished studies. We planned to extract data and assess the risk of bias and the certainty of evidence of the studies included, using the Quality in Prognosis Studies tool and the Grading of Recommendations Assessment. RESULTS: We were able to retrieve 2,407 citations using the search strategy, but none of the studies fulfilled the inclusion criteria. CONCLUSION: The clinical presentations, disease severity and prognoses of patients coinfected with SARS-CoV-2 and arboviruses remain unclear. Further prospective studies are necessary in order to provide useful information for clinical decision-making processes. Protocol registration number in the PROSPERO database: CRD42020183460

SARS-CoV-2 and arbovirus infection: a rapid systematic review.

BACKGROUND: The numbers of cases of arboviral diseases have increased in tropical and subtropical regions while the coronavirus disease (COVID-19) pandemic overwhelms healthcare systems worldwide. The clinical manifestations of arboviral diseases, especially dengue fever, can be very similar to COVID-19, and misdiagnoses are still a reality. In the meantime, outcomes for patients and healthcare systems in situations of possible syndemic have not yet been clarified. OBJECTIVE: We set out to conduct a systematic review to understand and summarize the evidence relating to clinical manifestations, disease severity and prognoses among patients coinfected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and arboviruses. METHODS: We conducted a rapid systematic review with meta-analysis, on prospective and retrospective cohorts, case-control studies and case series of patients with confirmed diagnoses of SARS-CoV-2 and arboviral infection. We followed the Cochrane Handbook recommendations. We searched EMBASE, MEDLINE, Cochrane Library, LILACS, Scopus and Web of Science to identify published, ongoing and unpublished studies. We planned to extract data and assess the risk of bias and the certainty of evidence of the studies included, using the Quality in Prognosis Studies tool and the Grading of Recommendations Assessment. RESULTS: We were able to retrieve 2,407 citations using the search strategy, but none of the studies fulfilled the inclusion criteria. CONCLUSION: The clinical presentations, disease severity and prognoses of patients coinfected with SARS-CoV-2 and arboviruses remain unclear. Further prospective studies are necessary in order to provide useful information for clinical decision-making processes. PROTOCOL REGISTRATION NUMBER IN THE PROSPERO DATABASE: CRD42020183460.

Neurocognitive impacts of arbovirus infections.

Arthropod-borne viruses or arbovirus, are most commonly associated with acute infections, resulting on various symptoms ranging from mild fever to more severe disorders such as hemorrhagic fever. Moreover, some arboviral infections can be associated with important neuroinflammation that can trigger neurological disorders including encephalitis, paralysis, ophthalmological impairments, or developmental defects, which in some cases, can lead to long-term defects of the central nervous system (CNS). This is well illustrated in Zika virus-associated congenital brain malformations but also in West Nile virus-induced synaptic dysfunctions that can last well beyond infection and lead to cognitive deficits. Here, we summarize clinical and mechanistic data reporting on cognitive disturbances triggered by arboviral infections, which may highlight growing public health issues spanning the five continents.

Perfil epidemiológico y clínico de casos de microcefalia / Perfil epidemiológico e clínico de casos de microcefalia / Epidemiological and clinical profile of microcephaly cases

OBJETIVO: Describir el perfil epidemiológico y clínico de los casos de microcefalia en Recife, Pernambuco. MÉTODO: Estudio transversal, cuantitativo, desarrollado en un hospital de referencia para casos de microcefalia. Los datos se recolectaron en agosto/2016 sobre la base del formulario FormSUS. Se incluyeron todos los casos de microcefalia confirmados de agosto/2015 a julio/2016, totalizando 180 casos. Para analizar los datos, se utilizó la estadística descriptiva y las pruebas de Chi-cuadrado y exacta de Fisher. RESULTADOS: La mayoría de los casos tuvieron lugar en octubre y noviembre de 2015, con 55 (30,6%) y 52 (28,9%), respectivamente. La serología para el virus Zika fue reactiva para 79 (43,9) bebés. El síntoma más prevalente durante el embarazo fue la erupción cutánea, 105 (57,3%). Además, 150 (83,3%) niños nacieron a término, 78 (43,3%) presentaron percentiles entre 10 y 50 en la relación peso y edad gestacional y 108 (60%) tuvieron -3 desviaciones estándar en la comparación del perímetro cefálico con la edad gestacional, considerada como microcefalia grave. CONCLUSIONES: Es necesario garantizar a estos niños una atención integral y especializada. Es imprescindible la vigilancia epidemiológica y entomológica, así como y acciones de control más eficaces en la lucha contra el vector

OBJETIVO: Descrever o perfil epidemiológico e clínico dos casos de microcefalia em Recife, Pernambuco. MÉTODO: Estudo transversal, quantitativo, desenvolvido em hospital de referência para casos de microcefalia. Os dados foram coletados em agosto/2016 a partir do formulário FormSUS. Foram incluídos todos os casos de microcefalia confirmados de agosto/2015 a julho/2016, perfazendo 180 casos. Para análise dos dados utilizou-se a estatística descritiva e os testes do qui-quadrado e exato de Fisher. RESULTADOS: A maioria dos casos ocorreram em outubro e novembro de 2015, com 55 (30,6%) e 52 (28,9%), respectivamente. A sorologia para o vírus Zika foi reagente para 79 (43,9%) dos bebês. O sintoma mais prevalente, durante a gestação, foi o exantema 105 (57,3%). Ademais, 150 (83,3%) crianças nasceram a termo, 78 (43,3%) apresentaram percentis entre 10 e 50 na relação peso e idade gestacional e 108 (60%) possuíam -3 desvios padrões na comparação do perímetro cefálico com a idade gestacional, considerada microcefalia severa. CONCLUSÕES: É necessário garantir a essas crianças um atendimento integral e especializado. É imprescindível a vigilância epidemiológica, entomológica e ações de controle mais efetivas no combate ao vetor

OBJECTIVE: To describe the epidemiological and clinical profile of microcephaly cases in Recife, Pernambuco. METHOD: This was a cross-sectional, quantitative study developed at a reference hospital for cases of microcephaly. Data were collected in August 2016 from the FormSUS system. All confirmed cases of microcephaly in the period from August 2015 to July 2016 were included, making up 180 cases. Data were analyzed using descriptive statistics and the chi-square and Fisher's exact tests. RESULTS: The majority of cases occurred in October and November 2015, with 55 (30.56%) and 52 (28.89%) cases, respectively. Serology for the Zika virus was reagent for 79 (43.89%) of the infants. The most prevalent symptom during gestation was exanthema 105 (57.3%). Furthermore, 150 (83.33%) of the children were born at full term, 78 (43.33%) presented percentiles between 10 and 50 in relation to weight and gestational age and 108 (60%) had -3 standard deviations in the comparison of head circumference with gestational age, thus considered to indicate severe microcephaly. CONCLUSIONS: It is necessary to guarantee comprehensive and specialized care for these children. Epidemiological and entomological surveillance and more effective control actions in the fight against the vector are necessary

Arboviruses (chikungunya, dengue, and Zika) associated with ophthalmic changes: a focus on aqueous fluid and vitreous humor.

The aim of this study was to conduct a bibliographic survey and correlates the presence of arboviroses in the eyeball with the main eye changes presented by the population under study. This study is a systematic review of journals and indexed articles, carried out between January 2019 and June 2019, in which there was a query in the Pubmed/Medline and Scielo databases without temporal restriction. In addition to the aforementioned databases, the Brazilian Association of Organ Transplantation Association database, which provides epidemiological data on organ and tissue transplants in Brazil, was used as a research source. The Midwest region contributed to the increase in the number of organ transplants in Brazil. The number of corneal transplants in Brazil surpassed the number of organ transplants by four times. Several ophthalmic changes associated with Chikungunya, Dengue, and Zika virus infections have been diagnosed; however, few studies have identified the presence of the virus in the eyeball. Arboviruses are of great relevance to public health due to a number of factors, ranging from the diversity of infectious agents involved and the plurality of clinical manifestations because the absence of efficient laboratory support, leading to delayed disease confirmation due to lack of differential diagnostics available. Added to these difficulties is the lack of specific therapy, leaving only the symptomatic control of clinical manifestations as the only treatment option. However, the manifestations are directly associated with the decreased quality of vision and consequently the quality of life of patients.

Factores de riesgo para mortalidad por dengue grave en pacientes pediátricos en el Hospital Mario Catarino Rivas / Risk factors for severe dengue mortality in pediatric patients at Mario Catarino Rivas

Antecedentes: El dengue es una enfermedad de presentación clínica variable, de manejo sencillo en la gran mayoría de las veces, ocasiona un enorme desafío al sistema de salud al presentarse en epidemias. Pacientes y métodos: Estudio de enfoque cuantitativo, no experimental, analítico de corte transversal, retrospectivo. Se analizaron el total de casos de dengue grave registrados en el Hospital Mario Catarino Rivas de enero a junio del año 2019 atendidos en las salas de observación, sala de dengue y UCIP (unidad de cuidados intensivos pediátricos). Se empleó muestreo por conveniencia, se registraron 5,000 casos de dengue, 287 con diagnóstico de dengue grave, constituyendo la muestra de estudio. Resultados: La edad promedio de 9.8 ± 3.4 años, El 57,5% de la muestra pertenece al género femenino, el restante 42,5% al masculino. En su totalidad el grupo estudiado presento fiebre, 70,03% dolor abdominal, 65,9% diarrea, 56,44% mialgias, 47,4% cefalea, 35,2% vómitos, 20,2% petequias y el 13,5% nauseas, entre sus complicaciones encontramos que el 94,07% presento estado de choque, 12,2% alteraciones ácido-base, y 6,6% mostro alteraciones neurológicas. Conclusiones: La principal prevención es interrumpir la cadena de transmisión, mediante el control de la infestación del vector, eliminando sus criaderos. Se requiere de educación sanitaria y reordenamiento ambiental, con participación comunitaria y multisectorial...(AU)

Simultaneous circulation of arboviruses and other congenital infections in pregnant women in Rio de Janeiro, Brazil.

BACKGROUND: Arboviruses (Zika, dengue and chikungunya) represent a major risk for pregnant women, especially because their vertical transmission can lead to neurological damage in newborns. Early diagnosis can be difficult due to similar clinical presentation with other congenital infections that are associated with congenital abnormalities. OBJECTIVES: To investigate the circulation of arboviruses and other pathogens responsible for congenital infections, reporting clinical aspects and geographic distribution of maternal rash in a metropolitan region of Rio de Janeiro (Brazil). METHODS: Cross-sectional study with pregnant women presenting rash attended at the Exanthematic Diseases Unit (Niterói, Rio de Janeiro) from 2015 to 2018. Diagnosis of arboviruses was performed by real-time PCR (RT-qPCR) and laboratorial screening for syphilis, toxoplasmosis, rubella, cytomegalovirus and HIV was assessed. Demographic data was used for georeferencing analysis. FINDINGS: We included 121 pregnant women, of whom Zika virus was detected in 45 cases (37.2%), chikungunya in 33 (27.3%) and dengue in one (0.8%). Five patients presented syphilis, and we observed one case each of listeria, cytomegalovirus, and a syphilis-toxoplasmosis case. Similarity of clinical symptoms was observed in all groups; however, 84.8% of patients with chikungunya presented arthralgia. Following the decline of Zika cases, chikungunya infection was mostly observed during 2017-2018. Considering pregnant women infected with arboviruses and other infections, 41% resided in urban slums, mostly in Niterói. MAIN CONCLUSIONS: Simultaneous circulation of arboviruses and other agents responsible for congenital infections were observed; however, we did not identify co-infections between arboviruses. In this scenario, we emphasize the importance of adequate prenatal care to provide an accurate diagnosis of maternal rash.

[Ocular manifestations of emerging arboviruses: Dengue fever, Chikungunya, Zika virus, West Nile virus, and yellow fever (French translation of the article)]. / Manifestations oculaires des arboviroses émergentes : dengue, chikungunya, infection à virus Zika, fièvre du Nil occidental et fièvre jaune.

Arboviruses are viral diseases transmitted by mosquitoes and tics bites. They are a major cause of morbidity and sometimes mortality. Their expansion is constant and due in part to climate change and globalization. Mostly found in tropical regions, arboviruses are sometimes the source of epidemics in Europe. Recently, the Chikungunya virus and the Zika virus were responsible for very large epidemics impacting populations that had never been in contact with those viruses. There are currently no effective antiviral treatments or vaccines. Ocular manifestations due to those infections are thus more frequent and increasingly better described. They are sometimes, as with Zika, complicated by a congenital ocular syndrome. The goal of this review is to describe the ophthalmological manifestations of Dengue fever, Chikungunya virus, Zika virus, West Nile virus, and yellow fever.

Microcephaly and arbovirus / Microcefalia y arbovirus

In this paper the relationship between the incidence of microcephaly and various arboviruses in current boom is exposed. It stands out that in the infection by the dengue virus, there have been no cases of microcephaly, however in the case series of chikungunya infection, incidence of cases with this affectation was reported, highlighting a cohort called CHIMERE; also the highest incidence of microcephaly associated with the mentioned Zika virus, which has been widely studied. All this, due to the neurotropism of these arboviruses.

En el presente trabajo se expone la relación existente entre incidencia de microcefalia y los diversos arbovirus en auge actual. Destaca que en la infección por el virus del dengue, no se ha registrado casos de microcefalia, sin embargo en las series de casos de infección por chikunguña, se reportó incidencia de casos con esta afectación, destacando una cohorte denominada CHIMERE; asimismo se menciona la mayor incidencia de microcefalia asociada al virus del Zika, la cual ha sido ampliamente estudiada. Todo lo anterior por el neurotropismo de estos arbovirus.

Caracterización general de Zika / General characterization of Zika

El Zika es un arbovirosis que causa enfer-medad febril caracterizada por fiebre, rash, artralgias y conjuntivitis no purulenta. En 2015 se registraron casos autóctonos en Brasil, en menos de un año el Zika se exten-dió a más de 30 países y territorios de Améri-ca Central, América del Sur, el Caribe y México, entre estos Honduras. Se ha rela-cionado con aumento de los casos de Gui- llain Barré y microcefalia en zonas donde produce epidemia. En Honduras, entre la semana epidemiológica 1 del 2016 a la 33 del 2017, hubo un total acumulado de 681 mujeres embarazadas con sospecha de Zika identificadas en el país, 125 de las cuales han sido confirmadas en laboratorio por reacción en cadena de polimerasa. Se reali-zó una revisión bibliográfica de 30 artículos tomando como referencia: artículos de revis-tas, normas y recomendaciones menores de 5 años de haber sido publicados o aquellos con importancia histórica, con el fin de brin-dar información útil al lector acerca del tema. Zika es una enfermedad que puede generar un impacto negativo en la salud de la niñez, dejando secuelas a largo plazo...(AU)

Virus Zika: manifestaciones cutáneas en 3 pacientes / Zika Virus: Cutaneous Manifestations in 3 Patients

La infección por el virus Zika debe sospecharse en viajeros o inmigrantes con clínica de viriasis (exantema, fiebre, artralgias, artritis, conjuntivitis, cefalea, etc.) y una historia epidemiológica compatible. Aunque las manifestaciones cutáneas se encuentran entre las más frecuentes no son específicas y su iconografía es escasa. Presentamos 3 casos, 2 viajeros y un inmigrante que comienzan con un exantema por virus Zika. Alcanzar el diagnóstico de forma rápida optimiza el manejo de estos pacientes, mejora el control de los casos graves y permite minimizar una posible transmisión autóctona dado el riesgo que supone la presencia del Aedes albopictus como potencial vector transmisor de esta enfermedad en el litoral mediterráneo español

Zika virus infection should be suspected in travelers or immigrants with the signs or symptoms of a viral infection (rash, fever, joint pains, conjunctivitis, headache, etc.) and a compatible epidemiological history. Although cutaneous manifestations are among the most common clinical signs of Zika, they are not specific and very few images are available. We present 3 patients (2 travelers and 1 immigrant) in whom a rash was the presenting manifestation of Zika virus infection. Prompt diagnosis optimizes outcomes in these patients, improves the management of severe disease, and minimizes the risk of local transmission by Aedes albopictus, now a potential local vector for the virus due to its presence in areas along Spain's Mediterranean coast

Vacinas para vírus emergentes

Dengue, Zika e chikungunya são nomes que passaram a fazer parte do dia a dia dos brasileiros. A busca por vacinas, tratamentos e métodos de prevenção contra a infeção dos chamados vírus emergentes está entre os grandes desafios da epidemiologia mundial. E novos agentes patológicos continuam a surgir. É o caso do arbovírus que causa a febre do Nilo Ocidental...Leia mais acessando o link

Dengue, chikungunya, zika y mayaro, amenazas para la salud en Honduras / Dengue, chikungunya, zika and mayaro, threats for the health of Honduras

El dengue es una enfermedad prevalente con antigüedad en Honduras, la cual dejó de ser la arbovirosis exclusiva del país con la aparición del chikungunya y del zika, debido al limitado control logrado frente al vector. Se considera asimismo la posibilidad de la introducción de nuevas enfermedades como la fiebre del mayaro. Objetivo: describir la condición actual de las arbovirosis presentes en Honduras y un posible surgimiento de la fiebre mayaro en el país. Material y Métodos: Se realizó una revisión a partir de artículos en español e inglés en las bases de datos HINARI, PUBMED y ESCOB-HOST, con los descriptores dengue, mayaro, chinkungunya, virus, zika virus y epidemiología. Conclusión: Honduras se encuentra en una frágil situación referente al desarrollo de nuevas arbovirosis y presenta factores que favorecen el surgimiento de nuevas variedades de virus entre la salud pública hondureña...(AU)