Post-Mortem Diagnosis of Pediatric Dengue Using Minimally Invasive Autopsy during the COVID-19 Pandemic in Brazil.

We report the first pediatric disease in which the use of minimally invasive autopsy (MIA) confirmed severe dengue as the cause of death. During the COVID-19 pandemic, a previously healthy 10-year-old girl living in north-eastern Brazil presented fever, headache, diffuse abdominal pain, diarrhoea, and vomiting. On the fourth day, the clinical symptoms worsened and the patient died. An MIA was performed, and cores of brain, lungs, heart, liver, kidneys, and spleen were collected with 14G biopsy needles. Microscopic examination showed diffuse oedema and congestion, pulmonary intra-alveolar haemorrhage, small foci of midzonal necrosis in the liver, and tubular cell necrosis in the kidneys. Dengue virus RNA and NS1 antigen were detected in blood and cerebrospinal fluid samples. Clinical, pathological, and laboratory findings, in combination with the absence of other lesions and microorganisms, allowed concluding that the patient had died from complications of severe dengue.

Analysis of BCL11A gene polymorphisms and hemolysis parameters in patients with sickle-cell disease / Análise dos polimorfismos do gene BCL11A e parâmetros de hemólise em pacientes com anemia falciforme

ABSTRACT Introduction: Patients with sickle-cell disease (SCD) present chronic hemolysis with increased serum biomarkers. Genetic polymorphisms of the BLC11A gene modulate fetal hemoglobin (HbF), thus reducing hemolysis Objective: To associate the polymorphisms of BCL11A gene with the hemolysis markers: reticulocyte, bilirubin, uric acid, lactate dehydrogenase (LDH), and methemoglobin (MetHb) in SCD patients. Methods: The study included 45 patients with SCD of both sexes using hydroxyurea (HU), treated at a Hospital in Fortaleza, Ceará, Brazil, along with 80 healthy individuals as the control group. MetHb, uric acid, and bilirubin measurements were carried out with the spectrophotometric method, and LDH with a kinetic method, a reticulocyte count by a manual method; and evaluation of BCL11A polymorphisms, in real time polymerase chain reaction (PCR). Data were analyzed using the statistical software GraphPad Prism. The level of significance was set at < 5%. Results: In region rs7557939 of the BCL11A gene genotype, A/G showed a significant increase of MetHb (p = 0.0297), and the A/A genotype showed high concentration of LDH (p = 0.0316) in the same region. The use of HU at doses ≥ 10 mg/kg/day showed a decrease of LDH (p = 0.02), and treatment for > 50 months was linked to the reticulocyte count (p = 0.0155). Conclusion: Polymorphisms in the rs7557939 region of the BCL11A gene appear to somehow interfere in the clinical setting of patients with SCD, suggesting relation with the concentration of MetHb and LDH. This study pioneered an investigation into the association of hemolysis biomarkers with BCL11A gene polymorphisms in SCD.

RESUMO Introdução: Pacientes com anemia falciforme (AF) apresentam hemólise crônica com biomarcadores séricos aumentados. Os polimorfismos genéticos do gene BLC11A modulam a hemoglobina fetal (HbF), reduzindo, assim, a hemólise. Objetivo: Associar os polimorfismos do gene BCL11A aos marcadores de hemólise: reticulócitos, bilirrubina, ácido úrico, lactato desidrogenase (LDH) e meta-hemoglobina (MetHb) em pacientes com AF. Métodos: O estudo incluiu 45 pacientes com AF que utilizavam hidroxiureia (HU), tratados em um hospital de Fortaleza, Ceará, Brasil, e 80 indivíduos saudáveis como grupo-controle. A dosagem de MetHb, ácido úrico e bilirrubina foi realizada por método espectrofotométrico; LDH, pelo método cinético; contagem de reticulócitos, pelo método manual; e avaliação de polimorfismos BCL11A, por reação em cadeia da polimerase (PCR) em tempo real. Os dados foram analisados usando o software estatístico GraphPad Prism. O nível de significância foi < 5%. Resultados: Na região rs7557939 do gene BCL11A, o genótipo A/G mostrou aumento significativo de MetHb (p = 0,0297), e o genótipo A/A esteve relacionado com a alta concentração de LDH (p = 0,0316). Pacientes em uso de HU em doses ≥ 10 mg/kg/dia apresentaram diminuição de LDH (p = 0,02), e o tratamento por mais de 50 meses foi relacionado com a contagem de reticulócitos (p = 0,0155). Conclusão: Polimorfismos na região rs7557939 do gene BCL11A parecem interferir de alguma forma nas manifestações clínicas de pacientes com AF, o que sugere uma relação com a concentração de MetHb e LDH. Este estudo foi pioneiro na investigação da associação de biomarcadores de hemólise com polimorfismos do gene BCL11A na AF.

In situ immune response and mechanisms of cell damage in central nervous system of fatal cases microcephaly by Zika virus.

Zika virus (ZIKV) has recently caused a pandemic disease, and many cases of ZIKV infection in pregnant women resulted in abortion, stillbirth, deaths and congenital defects including microcephaly, which now has been proposed as ZIKV congenital syndrome. This study aimed to investigate the in situ immune response profile and mechanisms of neuronal cell damage in fatal Zika microcephaly cases. Brain tissue samples were collected from 15 cases, including 10 microcephalic ZIKV-positive neonates with fatal outcome and five neonatal control flavivirus-negative neonates that died due to other causes, but with preserved central nervous system (CNS) architecture. In microcephaly cases, the histopathological features of the tissue samples were characterized in three CNS areas (meninges, perivascular space, and parenchyma). The changes found were mainly calcification, necrosis, neuronophagy, gliosis, microglial nodules, and inflammatory infiltration of mononuclear cells. The in situ immune response against ZIKV in the CNS of newborns is complex. Despite the predominant expression of Th2 cytokines, other cytokines such as Th1, Th17, Treg, Th9, and Th22 are involved to a lesser extent, but are still likely to participate in the immunopathogenic mechanisms of neural disease in fatal cases of microcephaly caused by ZIKV.

Postmortem Findings for 7 Neonates with Congenital Zika Virus Infection.

Postmortem examination of 7 neonates with congenital Zika virus infection in Brazil revealed microcephaly, ventriculomegaly, dystrophic calcifications, and severe cortical neuronal depletion in all and arthrogryposis in 6. Other findings were leptomeningeal and brain parenchymal inflammation and pulmonary hypoplasia and lymphocytic infiltration in liver and lungs. Findings confirmed virus neurotropism and multiple organ infection.

Post-pandemic influenza A (H1N1) 2009 virus infection in pregnant women in Ceará, Brazil.

OBJECTIVE: The aim of this study was to present results of the post-pandemic phase of A(H1N1)pdm09 virus infection in pregnant women in Ceará, Brazil, during the January-June 2012 influenza season. RESULTS: One hundred and fifty-four nasopharyngeal swab samples were collected from pregnant women admitted to hospitals with suspected severe acute respiratory infection (SARI). Fifty-three (34·4%) had laboratory-confirmed A(H1N1)pdm09 virus infection with 15 (28·3%) outpatients and 38 (71·7%) hospitalized. Five (9·4%) women were in the first trimester of pregnancy, 20 (37·7%) in the second trimester of pregnancy, and 24 (45·2%) in the third trimester of pregnancy. Three had no information about the time of pregnancy. Six samples from newborns were also analyzed, of which three were nasopharyngeal swab positive for A(H1N1)pdm09. These swabs were collected immediately after birth, with the exception of one that was collected on the day after birth. CONCLUSION: Our findings suggest that transplacental transfer of influenza viruses could occur as a result of severe illness in pregnancy. It is therefore important to encourage women to be vaccinated against influenza in order to avoid pregnancy complications.