Characterization of Dengue Virus 4 Cases in Paraguay, 2019-2020.

In 2019-2020, dengue virus (DENV) type 4 emerged to cause the largest DENV outbreak in Paraguay's history. This study sought to characterize dengue relative to other acute illness cases and use phylogenetic analysis to understand the outbreak's origin. Individuals with an acute illness (≤7 days) were enrolled and tested for DENV nonstructural protein 1 (NS1) and viral RNA by real-time RT-PCR. Near-complete genome sequences were obtained from 62 DENV-4 positive samples. From January 2019 to March 2020, 799 participants were enrolled: 253 dengue (14 severe dengue, 5.5%) and 546 other acute illness cases. DENV-4 was detected in 238 dengue cases (94.1%). NS1 detection by rapid test was 52.5% sensitive (53/101) and 96.5% specific (387/401) for dengue compared to rRT-PCR. DENV-4 sequences were grouped into two clades within genotype II. No clustering was observed based on dengue severity, location, or date. Sequences obtained here were most closely related to 2018 DENV-4 sequences from Paraguay, followed by a 2013 sequence from southern Brazil. DENV-4 can result in large outbreaks, including severe cases, and is poorly detected with available rapid diagnostics. Outbreak strains seem to have been circulating in Paraguay and Brazil prior to 2018, highlighting the importance of sustained DENV genomic surveillance.

Serum biomarkers and anti-flavivirus antibodies at presentation as indicators of severe dengue.

BACKGROUND: Dengue is the most common vector-borne viral disease worldwide. Most cases are mild, but some evolve into severe dengue (SD), with high lethality. Therefore, it is important to identify biomarkers of severe disease to improve outcomes and judiciously utilize resources. METHODS/PRINCIPAL FINDINGS: One hundred forty-five confirmed dengue cases (median age, 42; range <1-91 years), enrolled from February 2018 to March 2020, were selected from an ongoing study of suspected arboviral infections in metropolitan Asunción, Paraguay. Cases included dengue virus types 1, 2, and 4, and severity was categorized according to the 2009 World Health Organization guidelines. Testing for anti-dengue virus IgM and IgG and serum biomarkers (lipopolysaccharide binding protein and chymase) was performed on acute-phase sera in plate-based ELISAs; in addition, a multiplex ELISA platform was used to measure anti-dengue virus and anti-Zika virus IgM and IgG. Complete blood counts and chemistries were performed at the discretion of the care team. Age, gender, and pre-existing comorbidities were associated with SD vs. dengue with/without warning signs in logistic regression with odds ratios (ORs) of 1.07 (per year; 95% confidence interval, 1.03, 1.11), 0.20 (female; 0.05,0.77), and 2.09 (presence; 1.26, 3.48) respectively. In binary logistic regression, for every unit increase in anti-DENV IgG in the multiplex platform, odds of SD increased by 2.54 (1.19-5.42). Platelet count, lymphocyte percent, and elevated chymase were associated with SD in a combined logistic regression model with ORs of 0.99 (1,000/µL; 0.98,0.999), 0.92 (%; 0.86,0.98), and 1.17 (mg/mL; 1.03,1.33) respectively. CONCLUSIONS: Multiple, readily available factors were associated with SD in this population. These findings will aid in the early detection of potentially severe dengue cases and inform the development of new prognostics for use in acute-phase and serial samples from dengue cases.

Características epidemiológicas de los 190 pacientes internados con SARS-CoV2 en el Hospital General de Barrio Obrero periodo junio-diciembre 2020

RESUMEN El Hospital General de Barrio Obrero no es ajeno a la pandemia, teniendo pacientes hospitalizados con COVID-19 desde inicios de junio de 2020 con un impacto alto en los servicios. Se analizaron 190 pacientes internados en los distintos servicios. Se encontró predominio del sexo masculino 52%. En cuanto a la edad, se observó un claro predominio de gerontes con el 51% del total de pacientes170 (89%) fueron internados en el servicio de clínica médica, a pesar de eso, aún un bajo porcentaje se detectó en servicios como gineco-obstetricia y cirugía general. Según la evolución clínica de los pacientes, 138 (73%) fueron dados de alta, 29 (15%) fueron trasladados a un centro de mayor complejidad por complicación de la enfermedad y 23 (12%) fallecieron, 16 (70%) eran de sexo masculino, según el rango etario, los pacientes que obitaron eran gerontes 17 (74%), adultos mayores 4 (17%) y adultos jóvenes 2 (9%). Octubre fue el mes con más muertes en pacientes internados con SARS-CoV-2. .En cuanto a la comorbilidad, 91% presentaba al menos una comorbilidad, entre las que predominó la hipertensión arterial (25%)

ABSTRACT The Barrio Obrero General Hospital is no stranger to the pandemic, having hospitalized patients with COVID-19 since the beginning of June 2020 with a high impact on services. 190 patients admitted to the different services were analyzed. 52% male predominance was found. Regarding age, a clear predominance of elderly was observed with 51% of all patients170 (89%) were admitted to the medical clinic service, despite this, a low percentage was still detected in services such as gynecology. obstetrics and general surgery. According to the clinical evolution of the patients, 138 (73%) were discharged, 29 (15%) were transferred to a more complex center due to complications of the disease and 23 (12%) died, 16 (70%) were of male sex, according to age range, the patients who obtained were elderly 17 (74%), older adults 4 (17%) and young adults 2 (9%). October was the month with the most deaths in patients hospitalized with SARS-CoV-2. Regarding comorbidity, 91% had at least one comorbidity, among which arterial hypertension predominated (25%).