"Clock dial pattern", a radiologic clue to neuro-chikungunya diagnosis: a case series / "Padrão em ponteiro de relógio", uma dica radiológica para o diagnóstico de neurochikungunya: série de casos

Abstract Background Chikungunya is a mosquito-borne disease caused by the chikungunya virus (CHIKV) and can lead to neurological complications in severe cases. Objective This study examined neuroimaging patterns in chikungunya cases during two outbreaks in Brazil to identify specific patterns for diagnosis and treatment of neuro-chikungunya. Methods Eight patients with confirmed chikungunya and neurological involvement were included. Clinical examinations and MRI scans were performed, and findings were analyzed by neuroradiologists. Data on age, sex, neurological symptoms, diagnostic tests, MRI findings, and clinical outcomes were recorded. Results Patients showed different neuroimaging patterns. Six patients exhibited a "clock dial pattern" with hyperintense dotted lesions in the spinal cord periphery. One patient had thickening and enhancement of anterior nerve roots. Brain MRI revealed multiple hyperintense lesions in the white matter, particularly in the medulla oblongata, in six patients. One patient had a normal brain MRI. Conclusion The "clock dial pattern" observed in spinal cord MRI may be indicative of chikungunya-related nervous system lesions. Isolated involvement of spinal cord white matter in chikungunya can help differentiate it from other viral infections. Additionally, distinct brainstem involvement in chikungunya-associated encephalitis, particularly in the rostral region, sets it apart from other arboviral infections. Recognizing these neuroimaging patterns can contribute to early diagnosis and appropriate management of neuro-chikungunya.

Resumo Antecedentes A chikungunya é uma doença transmitida por mosquitos causada pelo vírus chikungunya (CHIKV) e pode levar a complicações neurológicas em casos graves. Objetivo Este estudo examinou padrões de neuroimagem em casos de chikungunya durante dois surtos no Brasil para identificar padrões específicos para o diagnóstico e tratamento de neurochikungunya. Métodos Oito pacientes com chikungunya confirmada e envolvimento neurológico foram incluídos. Exames clínicos e ressonâncias magnéticas (RM) foram realizados, e os achados foram analisados por neurorradiologistas. Dados sobre idade, sexo, sintomas neurológicos, testes diagnósticos, achados de RM e desfechos clínicos foram registrados. Resultados Os pacientes apresentaram diferentes padrões de neuroimagem. Seis pacientes apresentaram um "padrão de mostrador de relógio" com lesões pontilhadas hiperintensas na periferia da medula espinhal. Um paciente apresentou espessamento e realce das raízes nervosas anteriores. A RM do cérebro revelou múltiplas lesões hiperintensas na substância branca, especialmente no bulbo em seis pacientes. Um paciente apresentou uma RM cerebral normal. Conclusão O "padrão de mostrador de relógio" observado na RM da medula espinhal pode ser indicativo de lesões do sistema nervoso relacionadas à chikungunya. O envolvimento isolado da substância branca da medula espinhal na chikungunya pode ajudar a diferenciá-la de outras infecções virais. Além disso, o envolvimento distinto do tronco cerebral na encefalite associada à chikungunya, especialmente na região rostral, a distingue de outras infecções por arbovírus. O reconhecimento desses padrões de neuroimagem pode contribuir para o diagnóstico precoce e manejo adequado da neurochikungunya.

Spatio-Temporal Cluster Detection of Dengue, Chikungunya, and Zika Viruses' Infection in Rio de Janeiro State from 2010 to 2019.

Dengue (DENV), chikungunya (CHIKV), and Zika (ZIKV) virus infections are widespread throughout the Rio de Janeiro state. The co-circulation of these emergent arboviruses constitutes a serious public health problem, resulting in outbreaks that can spatially and temporally overlap. Environmental conditions favor the presence, maintenance, and expansion of Aedes aegypti, the primary vector of these urban arboviruses. This study assessed the detection of clusters of urban arboviruses in the Rio de Janeiro state from 2010 to 2019. Notified cases of dengue, chikungunya, and Zika were grouped by year according to the onset of symptoms and their municipality of residence. The study period recorded the highest number of dengue epidemics in the state along with the simultaneous circulation of chikungunya and Zika viruses. The analyzes showed that the central municipalities of the metropolitan regions were associated with higher risk areas. Central municipalities in metropolitan regions were the first most likely clusters for dengue and Zika, and the second most likely cluster for chikungunya. Furthermore, the northwest and north regions were comprised clusters with the highest relative risk for the three arboviruses, underscoring the impact of these arboviruses in less densely populated regions of Brazil. The identification of high-risk areas over time highlights the need for effective control measures, targeted prevention and control interventions for these urban arboviral diseases.

Clinical Diagnosis of Chikungunya Infection: An Essential Aid in a Primary Care Setting Where Serological Confirmation Is Not Available.

BACKGROUND: Chikungunya virus (CHIKV) diagnosis has become a challenge for primary care physicians in areas where the Zika virus and/or Dengue virus are present. Case definitions for the three arboviral infections overlap. METHODS: A cross-sectional analysis was carried out. A bivariate analysis was made using confirmed CHIKV infection as the outcome. Variables with significant statistical association were included in an agreement consensus. Agreed variables were analyzed in a multiple regression model. The area under the receiver operating characteristic (ROC) curve was calculated to determine a cut-off value and performance. RESULTS: 295 patients with confirmed CHIKV infection were included. A screening tool was created using symmetric arthritis (4 points), fatigue (3 points), rash (2 points), and ankle joint pain (1 point). The ROC curve identified a cut-off value, and a score ≥ 5.5 was considered positive for identifying CHIKV patients with a sensibility of 64.4% and a specificity of 87.4%, positive predictive value of 85.5%, negative predictive value of 67.7%, area under the curve of 0.72, and an accuracy of 75%. CONCLUSION: We developed a screening tool for CHIKV diagnosis using only clinical symptoms as well as proposed an algorithm to aid the primary care physician.

Vector Competence of Culex quinquefasciatus from Brazil for West Nile Virus.

West Nile virus is characterized as a neurotropic pathogen, which can cause West Nile fever and is transmitted by mosquitoes of the genus Culex. In 2018, the Instituto Evandro Chagas performed the first isolation of a WNV strain in Brazil from a horse brain sample. The present study aimed to evaluate the susceptibility of orally infected Cx. quinquefasciatus from the Amazon region of Brazil to become infected and transmit the WNV strain isolated in 2018. Oral infection was performed with blood meal artificially infected with WNV, followed by analysis of infection, dissemination, and transmission rates, as well as viral titers of body, head, and saliva samples. At the 21st dpi, the infection rate was 100%, the dissemination rate was 80%, and the transmission rate was 77%. These results indicate that Cx. quinquefasciatus is susceptible to oral infection by the Brazilian strain of WNV and may act as a possible vector of the virus since it was detected in saliva from the 21st dpi.

Dengue, chikungunya, and Zika virus infections in Latin America and the Caribbean: a systematic review.

Objectives: To characterize the distribution profile of dengue, chikungunya, and Zika virus infections in Latin America and the Caribbean and to identify possible factors associated with the risk of dissemination and severity of these arboviruses. Methods: The protocol of this review was registered on the PROSPERO platform. Searches were carried out in the following databases: Virtual Health Library, MEDLINE/PubMed, and Embase. The search terms were: Zika virus, Zika virus infection, dengue, dengue virus, chikungunya virus, chikungunya fever, epidemiology, observational study, Latin America, and Caribbean region. Studies that addressed the distribution of these arboviruses and the risk factors associated with dengue, Zika virus disease, and chikungunya, published between January 2000 and August 2020 in English, Portuguese, and Spanish, were included. Results: Of 95 studies included, 70 identified risk factors, clinical manifestations, and outcomes for arbovirus infections and 25 described complications and/or deaths. The highest frequency of confirmed cases was for dengue. Brazil reported most cases of the three arboviruses in the period analyzed. Environmental and socioeconomic factors facilitated the proliferation and adaptation of vectors, and host-related factors were reported to aggravate dengue. Most deaths were due to chikungunya, Zika virus disease caused most neurological alterations, and dengue resulted in greater morbidity leading to more frequent hospitalization. Conclusions: The review provides a broad view of the three arboviruses and the intrinsic aspects of infections, and highlights the factors that influence the spread of these viruses in the populations studied.

Fatores associados à infeção pelo vírus da dengue: estudo transversal de dados de vigilância em saúde do município de São Mateus (ES), entre os anos de 2016 e 2020 / Factors associated with dengue virus infection a cross-sectional: study of health surveillance data in the municipality of São Mateus (Espírito Santo), from 2016 to 2020 / Factores asociados a la infección por el virus del dengue: estudio transversal de datos de vigilancia en salud en la ciudad de Sao Mateus (ES), entre los años 2016 a 2020

Introdução: A dengue é uma doença infecciosa endêmica em regiões tropicais e subtropicais. Para organizar uma rede assistência de saúde e garantir medidas preventivas, manejo clínico adequado, é necessário conhecer os fatores associadas aos casos de dengue. Objetivo: Analisar os fatores associados à infecção pelo vírus da dengue de indivíduos notificados no sistema de vigilância em saúde. Métodos: Estudo transversal de dados secundários de casos de suspeitos de dengue notificados no Sistema Nacional de Informação de Agravos de Notificação. Foram incluídos os indivíduos notificados com suspeita de dengue com data de notificação entre dia 1º de janeiro de 2016 e 31 de dezembro de 2020 e que residiam em São Mateus (ES). Foram calculadas as frequências relativas e absolutas das variáveis e foi utilizada a regressão de Poisson de variância robusta para calcular a razão de prevalência (RP) e estimar os intervalos de confiança de 95% (IC95%). Resultados: Foram notificados 4.547 casos suspeitos de dengue, 2.438 (53,8%) casos foram confirmados, 844 (27,7%) confirmados por critério laboratorial, nove apresentaram sinais de alarme, três foram de dengue grave, 35 necessitaram de internação hospitalar e quatro evoluíram a óbito por dengue. A faixa etária ≥60 anos (RP=1,28; IC95% 1,14­1,45), indivíduos com cinco a oito anos de estudo (RP=1,47; IC95% 1,19­1,81), com prova do laço positiva (RP=1,40; IC95% 1,22­1,60) e diabetes mellitus (RP=4,19; IC95% 1,91­9,20) apresentaram maiores prevalências de dengue. Conclusão: A prevalência da dengue foi maior no grupo de indivíduos com idade maior e igual a 60 anos, com cinco a oito anos de estudo, com diabetes mellitus, que apresentaram prova do laço positiva e leucopenia. Esses grupos apresentam chances maiores de desenvolvimento da dengue grave, sendo necessários esforços dos serviços de assistência e vigilância em saúde em seu manejo clínico.

Introduction: Dengue is an endemic infectious disease in tropical and subtropical regions. Knowing the factors associated with dengue cases is necessary to organize the health care system and ensure preventive measures and proper clinical management. Objective: To analyze the factors associated with dengue virus infection in cases reported to the health surveillance system. Methods: This is a cross-sectional study of secondary data on suspected dengue cases reported to the Information System on Diseases of Compulsory Declaration. The sample included individuals with a report of suspected dengue made between January 1, 2016, and December 31, 2020, who lived in São Mateus (Espírito Santo). We calculated the relative and absolute frequencies of the variables and used Poisson regression with robust variance to estimate the prevalence ratio (PR) and 95% confidence intervals (95%CI). Results: A total of 4,547 suspected dengue cases were reported, of which 2,438 (53.8%) were confirmed, 844 (27.7%) were confirmed by laboratory criteria, nine presented warning signs, three had severe dengue, 35 required hospitalization, and four died from dengue. The prevalence of dengue was higher in the age group ≥60 years (PR=1.28; 95%CI 1.14­1.45), individuals with five to eight years of schooling (PR=1.47; 95%CI 1.19­1.81), with positive tourniquet test (PR=1.40; 95%CI 1.22­1.60), and diabetes mellitus (PR=4.19; 95%CI 1.91­9.20). Conclusions: Dengue was more prevalent among individuals aged 60 years and older, with five to eight years of schooling, diabetes mellitus, positive tourniquet test, and leukopenia. These groups are more likely to develop severe dengue, requiring efforts from health care and surveillance services for their clinical management.

Introducción: El dengue es una enfermedad infecciosa endémica en las regiones tropicales y subtropicales. Para organizar una red de atención en salud y asegurar medidas preventivas, manejo clínico adecuado, es necesario conocer los factores asociados a los casos de dengue. Objetivo: Analizar los factores asociados a la infección por el virus del dengue en personas notificadas en el sistema de vigilancia en salud. Métodos: Estudio transversal de datos secundarios sobre casos sospechosos de dengue notificados en el Sistema Nacional de Información de Enfermedades de Declaración Obligatoria. Se incluyeron personas notificadas con sospecha de dengue con fecha de notificación entre el 1 de enero de 2016 y el 31 de diciembre de 2020 y residentes en Sao Mateus (ES). Se calcularon las frecuencias relativas y absolutas de las variables y se utilizó regresión de Poisson de varianza robusta para calcular la razón de prevalencia (RP) y se estimaron los intervalos de confianza del 95% (IC95%). Resultados: Se notificaron 4.547 casos sospechosos de dengue, se confirmaron 2.438 (53,8%), se confirmaron por criterio de laboratorio 844 (27,7%), nueve casos presentaron signos de alarma, tres casos presentaron dengue grave, 35 casos requirieron hospitalización y cuatro fallecieron por dengue. El grupo de edad ≥60 años (RP=1,28 ­ IC95% 1,14­1,45), con escolaridad de 5 a 8 años (RP=1,47 ­ IC95% 1,19­1,81), prueba de torniquete positiva (RP=1,40 ­ IC95% 1,22­1,60) y diabetes mellitus (RP=4,19 ­ IC95% 1,91­9,20) presentaron mayor prevalencia de dengue. Conclusión: la prevalencia de dengue es mayor en el grupo de individuos mayores de 60 años, entre 5 y 8 años de escolaridad, con diabetes mellitus, con vínculo positivo comprobado y leucopenia. Estos grupos son más propensos a desarrollar dengue grave, lo que requiere esfuerzos de los servicios de salud y vigilancia en el manejo clínico de estos individuos.

Incidência e sazonalidade de casos de Chikungunya no estado do Rio de Janeiro, 2017-2020 / Incidence and seasonality of chikungunya cases in the state of Rio de Janeiro, 2017-2020 / Incidencia y estacionalidad de casos de chikungunya en el estado de Rio de janeiro, 2017-2020

Objetivo: descrever a incidência e a sazonalidade de casos notificados no Sistema de Informação de Agravos de Notificação, no estado do Rio de Janeiro, no período de 2017 a 2020. Método: estudo ecológico descritivo, com análise de dados disponibilizados pelo Departamento de Informática do Sistema Único de Saúde. Resultados: foram notificados 156.579 casos no período; 5.970 em 2017; 45.429 em 2018; 99.436 em 2019; e 5.744 em 2020; quanto à sazonalidade, em 2017 destacaram-se os meses de maio a julho; em 2018 e 2019, os meses de abril a junho; e em 2020, o período de janeiro a março. Conclusão: faz-se necessária a intensificação de ações de vigilância nas regiões de maior incidência, direcionando as políticas de controle

Objective: describe the incidence and seasonality of cases reported in the notifiable diseases information system, in the state of Rio de Janeiro, from 2017 to 2020. Method: descriptive ecological study, with analysis of data provided by the Department of Informatics of the Unified Health System. Results: 156,579 cases were reported in the period; 5,970 in 2017; 45,429 in 2018; 99,436 in 2019; and 5,744 in 2020; as for seasonality, in 2017 the months from may to july stood out; in 2018 and 2019, the months from april to june; and in 2020, the period from january to march. Conclusion: it is necessary to intensify surveillance actions in regions with the highest incidence in order to direct control policies

Objetivos: describir la incidencia y la estacionalidad de los casos notificados en el sistema de información de enfermedades de declaración obligatoria, en el estado de Río de Janeiro, de 2017 a 2020. Método: estudio ecológico descriptivo, con análisis de datos proporcionados por el Departamento de Informática del Sistema Único de Salud. Resultados: 156.579 casos fueron notificados en el período; 5.970 en 2017; 45.429 en 2018; 99.436 en 2019; y 5.744 en 2020; en cuanto a la estacionalidad, en 2017 destacaron los meses de mayo a julio; en 2018 y 2019, los meses de abril a junio; y en 2020, el período de enero a marzo. Conclusión: es necesario intensificar las acciones de vigilancia en las regiones de mayor incidencia para orientar las políticas de control

Avaliação do desenvolvimento tecnológico em saúde a partir da ocorrência das epidemias de zika e chikungunya no Brasil / Evaluation of technological development in health from the occurrence of the zika and chikungunya epidemics in Brazil / Evaluación del desarrollo tecnológico en salud desde la ocurrencia de las epidemias de zika y chikunguña en Brasil

Buscando compreender como as epidemias de zika e chikungunya incitaram o desenvolvimento tecnológico, este estudo realizou levantamento de dados epidemiológicos e prospecção tecnológica, utilizando dados do Instituto Nacional da Propriedade Industrial (INPI) e do Orbit Intelligence. Ainda, analisou produtos desenvolvidos e em desenvolvimento a nível mundial e aqueles registrados no Brasil por meio da Agência Nacional de Vigilância Sanitária (Anvisa). No ano de 2016, observou-se o maior número de casos totais para ambas as doenças. A prospecção tecnológica nacional revelou que há interesse global em desenvolver tecnologias para essas doenças e depositar suas patentes no Brasil, tendo as empresas como principais depositantes. Por sua vez, a prospecção tecnológica global mostrou que o ano de 2016 configura-se como importante marco na evolução do número de patentes para zika e chikungunya, sugerindo que as epidemias brasileiras estimularam o mundo no desenvolvimento de novos insumos para a saúde. Os Estados Unidos e a China são as principais jurisdições, tendo as universidades como maiores depositantes. A análise de produtos a nível global revelou que apenas dois chegaram ao mercado para zika e um para chikungunya, e as vacinas estão na categoria principal. A busca na Anvisa revelou que há mais produtos registrados para zika do que em comparação à chikungunya. Os principais fabricantes legais são empresas brasileiras, com pedidos de registro realizados principalmente pelas empresas DiaSorin S.p.A., ECO Diagnóstica Ltda. e Chembio Diagnostics Brazil Ltda. Apesar do visível estímulo à pesquisa, desenvolvimento e patenteamento gerado pelas epidemias de zika e chikungunya no Brasil, isso não garantiu a chegada de novos produtos ao mercado nem acesso da população a eles.

This study aims to understand how the zika and chikungunya epidemics incited technological development. We surveyed epidemiological data and technological prospecting, using data from Brazilian National Institute of Industry Property (INPI) and Orbit Intelligence, and analyzed products developed/under development worldwide and products registered in Brazil by Brazilian Health Regulatory Agency (Anvisa). In 2016, the highest number of total cases was observed for both diseases. Brazil's technological prospection revealed the existence of a global interest in developing technologies for these diseases and filing their patents in Brazil, with companies as the main depositors. Global technological prospecting showed that 2016 is an important milestone in the evolution of the number of patents for zika and chikungunya, suggesting that Brazilian epidemics stimulated the world in the development of new health inputs. The United States and China are the main jurisdictions, with universities as the largest depositors. Global product analysis revealed that only two products reached the market for zika and one for chikungunya, and vaccines are in the top category. A research in Anvisa revealed more products registered for zika compared to chikungunya. The main legal manufacturers are Brazilian companies, with DiaSorin S.p.A., Eco Diagnóstica Ltda., and Chembio Diagnostics Brazil Ltda. leading the registration requests. Despite the visible stimulus to research, development, and patenting generated by the zika and chikungunya epidemics in Brazil, such stimulus did not guarantee the arrival of new products on the market and population access to these products.

Con el fin de comprender cómo las epidemias de zika y chikunguña estimularon el desarrollo tecnológico, este estudio realizó la recopilación de datos epidemiológicos y la prospección tecnológica, utilizando datos del Instituto Nacional de la Propiedad Industrial (INPI) y Orbit Intelligence, y analizó los productos desarrollados y en desarrollo en todo el mundo y productos registrados en Brasil por la Agencia Nacional de Vigilancia Sanitaria (Anvisa). En 2016 se observó el mayor número de casos para ambas enfermedades. La prospección tecnológica nacional reveló que existe un interés mundial por desarrollar tecnologías para estas enfermedades y depositar sus patentes en Brasil, con las empresas como los principales depositantes. La prospección tecnológica mundial mostró que 2016 fue un hito importante en la evolución del número de patentes de zika y chikunguña, lo que sugiere que las epidemias brasileñas estimularon el desarrollo mundial de nuevos insumos para la salud. EE.UU. y China son las principales jurisdicciones, con las universidades como las mayores depositantes. El análisis global de productos reveló que solo 2 han llegado al mercado para zika y 1 para chikunguña, y las vacunas están en la categoría superior. La búsqueda en Anvisa reveló la existencia de más productos registrados para zika que para chikunguña. Los principales fabricantes legales son empresas brasileñas, con las solicitudes de registro realizadas principalmente por DiaSorin S.p.A., Eco Diagnóstica Ltda. y Chembio Diagnostics Brazil Ltda. Aunque hubo una notable promoción a la investigación, desarrollo y patentamiento generado por las epidemias de zika y chikunguña en Brasil, esto no implicó la llegada de nuevos productos al mercado y el acceso a ellos por parte de la población.

Dengue no Brasil: fatores socioambientais associados a prevalência de casos / Dengue in Brazil: socio-environmental factors associated with the prevalence of cases / Dengue en Brasil: factores sociales y ambientales asociados a la prevalencia de casos

A dengue é uma das doenças virais mais distribuídas pelo mundo. Por meio de uma revisão integrativa, este estudo busca identificar os possíveis fatores socioambi- entais associados à prevalência dos casos de dengue. Foi realizada uma pesquisa em es- tudos indexados nas bases de dados: Biblioteca Virtual em Saúde (BVS) e Literatura La- tino-Americana e do Caribe em Ciências da Saúde (LILACS), no período de 2017 a 2023, utilizando-se os seguintes descritores (DeCS): dengue, aedes aegypti e infecções por ar- bovírus. Em seguida, foram selecionados quinze trabalhos, que foram publicados em por- tuguês e espanhol. Os resultados mostraram que a dengue está relacionada a diversos fatores, ligados a esfera social e ambiental. Inicialmente, observou-se que o crescimento urbano desordenado desencadeou uma série de questões que contribuem para o aumento dos casos de dengue e o consequente impacto sobre a saúde pública. Entre os principais fatores sociais, verificou-se um crescimento populacional nas cidades, o que levou ao agravamento da desigualdade social, elevação das moradias precárias e necessidade de melhor infraestrutura. Entre os principais fatores ambientais, pode-se destacar a deficiên- cia no fornecimento de água, o que costuma levar as pessoas a buscarem armazenar água em reservatórios descobertos. Além disso, é comum a ocorrência do manejo inadequado dos resíduos sólidos. Portanto, o trabalho evidenciou os fatores que estão associados à prevalência da dengue, assim como mostrou a necessidade de investimento em diversas áreas, no intuito de diminuir a desigualdade social.

Dengue is one of the most widespread viral diseases in the world. Through an integrative review, this study seeks to identify possible socio-environmental factors associated with the prevalence of dengue cases. A search was carried out on studies in- dexed in the databases: Virtual Health Library (BVS) and Latin American and Caribbean Literature on Health Sciences (LILACS), from 2017 to 2023, using the following de- scriptors (DeCS): dengue, aedes aegypti and arbovirus infections. Then, fifteen works were selected, which were published in Portuguese and Spanish. The results showed that dengue is related to several factors, linked to the social and environmental sphere. Ini- tially, it was observed that disorderly urban growth has triggered a series of issues that contribute to the increase in dengue cases and the consequent impact on public health. Among the main social factors, there was a population growth in the cities, which led to the worsening of social inequality, an increase in precarious housing and the need for better infrastructure. Among the main environmental factors, we can highlight the defi- ciency in the water supply, which usually leads people to seek to store water in uncovered reservoirs. In addition, the occurrence of inadequate management of solid waste is com- mon. Therefore, the work highlighted the factors that are associated with the prevalence of dengue, as well as showing the need for investment in several areas, in order to reduce social inequality.

El dengue es una de las enfermedades virales más extendidas en el mundo. A través de una revisión integradora, este estudio busca identificar posibles factores so- cioambientales asociados a la prevalencia de casos de dengue. Se realizó una búsqueda en estudios indexados en las bases de datos: Biblioteca Virtual en Salud (BVS) y Litera- tura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), de 2017 a 2023, utilizando los siguientes descriptores (DeCS): dengue, aedes aegypti y arbovirus infec- ciones Luego, quince obras fueron seleccionadas, que fueron publicadas en portugués y español. Los resultados mostraron que el dengue está relacionado con varios factores, vinculados a las esferas social y ambiental. Inicialmente, se observó que el crecimiento urbano desordenado desencadenó una serie de problemas que contribuyen al aumento de casos de dengue y el consecuente impacto en la salud pública. Entre los principales fac- tores sociales, hubo un crecimiento de la población en las ciudades, lo que condujo al recrudecimiento de la desigualdad social, aumento de la vivienda precaria y la necesidad de mejorar la infraestructura. Entre los principales factores ambientales, se puede destacar la deficiencia en el suministro de agua, lo que suele llevar a las personas a buscar alma- cenar agua en reservorios descubiertos. Además, es común la ocurrencia de un inade- cuado manejo de los residuos sólidos. Por lo tanto, el trabajo destacó los factores que están asociados a la prevalencia del dengue, además de mostrar la necesidad de inversión en varias áreas, con el fin de reducir la desigualdad social.

Conocimientos de los residentes de Medicina General Integral sobre prevención y control de las arbovirosis / Comprehensive General Medicine residents: their knowledge about prevention and control of arboviruses

Fundamento: las arbovirosis son enfermedades víricas transmitidas por mosquitos, las que han propagado rápidamente en todas las regiones del mundo en los últimos años, con alta incidencia en la salud de las personas y en la economía de los países. Objetivo: identificar el nivel de conocimientos de los residentes de Medicina General Integral del municipio Abreus, sobre la prevención y control de las arbovirosis. Métodos: se realizó un estudio observacional, descriptivo, de corte transversal, en la Dirección Municipal de Salud Abreus, en octubre de 2021. Se utilizaron métodos teóricos y empíricos para fundamentar la investigación, y estadísticos para el análisis de los datos encontrados. Resultados: la mayoría de los residentes manifestaron que han tenido preparación sobre la prevención y control de las arbovirosis, fundamentalmente, durante la educación en el trabajo, todos han adquirido experiencia previa en la pesquisa activa, y algunos señalaron haber atendido a enfermos; sin embargo, la mayoría presentaron dificultades para identificar las formas clínicas y el cuadro clínico de las arbovirosis. Conclusiones: se identificó el nivel de conocimientos alcanzados por los residentes de Medicina General Integral del municipio Abreus, sobre la prevención y control de las arbovirosis, el diagnóstico realizado mostró la necesidad de asumir nuevas metodologías en la educación en el trabajo a fin de lograr correctos modos de actuación y actualización sobre su prevención y control.

Background: arboviruses are viral diseases transmitted by mosquitoes, which have spread rapidly in all regions of the world in recent years, with a high impact on people's health and the economies of countries. Objective: to identify the level of knowledge of Comprehensive General Medicine residents from the Abreus municipality, about the prevention and control of arboviruses. Methods: an observational, descriptive, cross-sectional study was carried out at the Abreus Municipal Health Directorate, in October 2021. Theoretical and empirical methods were used to support the research, and statistical methods were used to analyze the data found. Results: most residents stated that they have had training on the prevention and control of arboviruses, mainly, during on-the-job education, all have acquired previous experience in active search, and some of them indicated had taken care for sick people; however, most of them had difficulties in identifying the clinical forms and clinical profile of arboviruses. Conclusions: the level of knowledge achieved by Comprehensive General Medicine residents from Abreus municipality was identified, regarding the prevention and control of arboviruses, the diagnosis made by them showed the need to conceive new methodologies in education at work in order to achieve adequate modes of action and updating their knowledge about the prevention and control of it.

Spatial analysis of Chikungunya fever incidence and the associated socioeconomic, demographic, and vector infestation factors in municipalities of Pernambuco, Brazil, 2015-2021 / Análise espacial da incidência da febre de Chikungunya e dos fatores socioeconômicos, demográficos e de infestação vetorial associados, em municípios de Pernambuco, Brasil, 2015-2021

ABSTRACT Objective: To identify the spatial patterns of chikungunya fever (CHIKF) and the associated socioeconomic, demographic, and vector infestation factors in the 1st Health Region of Pernambuco (1st HRP). Methods: This ecological study used a spatial analysis of Mean Incidence Rates (MIR) of probable cases of CHIKF reported among residents of the 19 municipalities of the 1st HRP, in 2015-2021. The univariate and bivariate global Moran indexes (I) were estimated. From the significant associations (p<0.05), clusters were identified using the local Moran index and maps. Results: A predominance of the largest CHIKF rates was identified in the east. However, there was a heterogeneous distribution of rates across municipalities, which may have contributed to the absence of spatial autocorrelation of CHIKF (I=0.03; p=0.294) in univariate I. The bivariate I revealed a positive spatial correlation between CHIKF and the Municipal Human Development Index (MHDI) (I=0.245; p=0.038), but with a cluster of cities with low incidences and low MHDI in the west. There was no spatial correlation between CHIKF and the other variables analyzed: population density, Gini index, social vulnerability index, and building infestation index for Aedes aegypti. Conclusions: The results suggest that only the MHDI influenced the occurrence of CHIKF in the 1st HRP, so that municipalities in the west demonstrated spatial dependence between lower values of MHDI and MIR. However, this spatial correlation may have occurred due to possible underreporting in the area. These findings can assist in the (re)orientation of resources for surveillance and health care services.

RESUMO Objetivo: Identificar, na Iᵃ Região de Saúde de Pernambuco (Iᵃ RSP), os padrões espaciais da febre de Chikungunya (CHIKF) e os fatores socioeconômicos, demográficos e de infestação vetorial associados. Métodos: Este estudo ecológico utilizou a análise espacial das Taxas Médias de Incidência (TMI) de casos prováveis da CHIKF notificados entre os residentes dos 19 municípios da Iᵃ RSP no período de 2015-2021. Os índices de Moran global (I) univariados e bivariados foram estimados. Das associações significativas (p<0,05), clusters foram localizados por meio do Índice de Moran Local e de mapas. Resultados: Identificou-se predominância das maiores TMI da CHIKF no leste. Entretanto, houve distribuição heterogênea das taxas dos municípios, o que pode ter contribuído para a ausência de autocorrelação espacial da CHIKF (I=0,03; p=0,294) no I univariado. O I bivariado revelou correlação espacial positiva entre a CHIKF e o Índice de Desenvolvimento Humano Municipal (IDHM) (I=0,245; p=0,038), porém com um cluster de cidades com baixas incidências e baixo IDHM no oeste. Não houve correlação espacial entre a CHIKF e as demais variáveis analisadas: densidade demográfica, Índice de Gini, Índice de Vulnerabilidade Social e Índice de Infestação Predial de Aedes aegypti. Conclusões: Os resultados sugerem que somente o IDHM influenciou na ocorrência da CHIKF na Iᵃ RSP, de forma que municípios do oeste demonstraram dependência espacial entre menores valores de IDHM e TMI. No entanto, essa correlação espacial pode ter ocorrido devido às possíveis subnotificações na área. Tais achados podem auxiliar na (re)orientação de recursos dos serviços de vigilância e assistência à saúde.

Dengue, chikungunya, and Zika virus infections in Latin America and the Caribbean: a systematic review / Infecciones por dengue, chikungunya y el virus de Zika en América Latina y el Caribe: revisión sistemática / Dengue, zika e chikungunya na América Latina e no Caribe: revisão sistemática

ABSTRACT Objectives. To characterize the distribution profile of dengue, chikungunya, and Zika virus infections in Latin America and the Caribbean and to identify possible factors associated with the risk of dissemination and severity of these arboviruses. Methods. The protocol of this review was registered on the PROSPERO platform. Searches were carried out in the following databases: Virtual Health Library, MEDLINE/PubMed, and Embase. The search terms were: Zika virus, Zika virus infection, dengue, dengue virus, chikungunya virus, chikungunya fever, epidemiology, observational study, Latin America, and Caribbean region. Studies that addressed the distribution of these arboviruses and the risk factors associated with dengue, Zika virus disease, and chikungunya, published between January 2000 and August 2020 in English, Portuguese, and Spanish, were included. Results. Of 95 studies included, 70 identified risk factors, clinical manifestations, and outcomes for arbovirus infections and 25 described complications and/or deaths. The highest frequency of confirmed cases was for dengue. Brazil reported most cases of the three arboviruses in the period analyzed. Environmental and socioeconomic factors facilitated the proliferation and adaptation of vectors, and host-related factors were reported to aggravate dengue. Most deaths were due to chikungunya, Zika virus disease caused most neurological alterations, and dengue resulted in greater morbidity leading to more frequent hospitalization. Conclusions. The review provides a broad view of the three arboviruses and the intrinsic aspects of infections, and highlights the factors that influence the spread of these viruses in the populations studied.

RESUMEN Objetivos. Caracterizar el perfil de distribución de infecciones por dengue, chikungunya y el virus de Zika en América Latina y el Caribe, y determinar posibles factores relacionados con el riesgo de propagación y gravedad de estas arbovirosis. Métodos. Se registró el protocolo de esta revisión en la plataforma PROSPERO. Se realizaron búsquedas en las siguientes bases de datos: Virtual Health Library, MEDLINE/PubMed y Embase. Los términos de búsqueda fueron: "zika virus" [virus del Zika], "zika virus infection" [infección por el virus del Zika], "dengue", "dengue virus" [virus del dengue], "chikungunya virus" [virus del chikunguña], "chikungunya fever" [fiebre de chikunguña], "epidemiology" [epidemiología], "observational study" [estudio observacional], "Latin America" [América Latina] y "Caribbean región" [Caribe]. Se incluyeron estudios que abordaban la distribución de estas arbovirosis y los factores de riesgo asociados con el dengue, la enfermedad por el virus del Zika y el chikunguña, publicados entre enero del 2000 y agosto del 2020 en español, inglés y portugués. Resultados. De los 95 estudios incluidos, 70 establecieron factores de riesgo, manifestaciones clínicas y resultados de las infecciones por arbovirus y 25 describieron complicaciones o muertes. La mayor frecuencia de casos confirmados fue del dengue. Brasil notificó la mayoría de los casos de infección por los tres arbovirus en el período analizado. Los factores ambientales y socioeconómicos facilitaron la proliferación y adaptación de los vectores, y se notificó que los factores relacionados con el huésped agravaban el dengue. El chikunguña causó la mayor parte de las muertes, la enfermedad por el virus del Zika causó la mayor parte de las alteraciones neurológicas y el dengue fue responsable de una mayor morbilidad, lo que llevó a una hospitalización más frecuente. Conclusiones. Esta revisión ofrece un panorama de las tres arbovirosis y de los aspectos intrínsecos de las infecciones, y pone de relieve los factores que influyen en la propagación de estos virus en las poblaciones estudiadas.

RESUMO Objetivos. Descrever a distribuição das arboviroses causadas pelo vírus da dengue, zika e chikungunya na América Latina e no Caribe e identificar possíveis fatores associados ao potencial de disseminação e à gravidade dessas infecções. Métodos. O protocolo desta revisão sistemática foi registado na plataforma PROSPERO. Foram realizadas buscas nas bases de dados Biblioteca Virtual em Saúde, MEDLINE/PubMed e Embase. Os termos de busca foram: vírus zika, infecção pelo vírus zika, dengue, vírus da dengue, vírus chikungunya, febre chikungunya, epidemiologia, estudo observacional, América Latina e região do Caribe. Foram selecionados estudos publicados em inglês, português e espanhol, entre janeiro de 2000 e agosto de 2020, que tratavam da distribuição desses arbovírus e de fatores de risco associados à dengue, à infecção pelo vírus zika e à febre chikungunya. Resultados. Dos 95 estudos selecionados, 70 descreveram fatores de risco, manifestações clínicas e desfechos das arboviroses e 25 destacaram as complicações e/ou mortes. Houve uma maior taxa de casos confirmados de dengue. O Brasil foi o país onde se registrou a maioria dos casos dessas três arboviroses no período analisado. Fatores ambientais e socioeconômicos facilitaram a proliferação e a adaptação dos vetores dos arbovírus e fatores próprios do hospedeiro são determinantes na gravidade da dengue. As mortes ocorreram principalmente nos casos de febre chikungunya, as manifestações neurológicas foram mais comuns na infecção pelo vírus zika e a dengue resultou em maior morbidade e internação hospitalar. Conclusões. Esta revisão sistemática oferece um panorama destas três arboviroses e de suas peculiaridades destacando os fatores que influenciam a disseminação destes arbovírus nas populações estudadas.

Application and consideration of metagenomic next-generation sequencing technology in the diagnosis of insect-borne diseases / 中华检验医学杂志

Insect-borne diseases are serious life-threatening infectious diseases. Rapid and accurate etiological diagnosis are the premise of timely and effective clinical treatments, reducing mortality and sequelae. Laboratory diagnoses of insect-borne diseases mainly focus on targeted serological detection and polymerase chain reaction, which is difficult to detect rare insect borne pathogens. At present, the metagenomic next-generation sequencing (mNGS) technology has moved from scientific research into clinical application. The detection of nucleic acid sequences of all organisms in infected samples by mNGS exhibited significant advantages in the diagnosis and traceability of rare pathogens. But at the same time, mNGS is also suffered with challenges such as background microbial interference, false results caused by database restrictions, pathogen resistance and host immune status information that are urgently needed for clinical treatments. This article systematically summarized applications of mNGS in the diagnosis of insect-borne pathogens and the challenges and difficulties it faces. With the continuous optimization of mNGS in the detection, it will bring new development and innovation to the etiology diagnosis of clinical infectious diseases.

Point-of-care testing technology and experimental diagnosis of insect-borne diseases: applications and challenges / 中华检验医学杂志

Insect-borne infections are causing serious public health concerns worldwide. Point-of-care testing technology for insect-borne diseases can rapidly and accurately determine the pathogens, thus it plays an important role in the application of portable disease control measurements. This article provides an overview of the point-of-care testing technology for insect-borne infectious diseases regarding its application, advantages and limitations in experimental diagnoses, and its future trends.

Emphasis of rapid and accurate laboratory diagnosis of insect-borne infectious diseases / 中华检验医学杂志

In recent years, with the change of natural and social factors, such as climate warming, urbanization, land reclamation, human population growth, change of life customs, and convenient transportation, the human infectious diseases transmitted by insect vectors, well known as insect-borne infectious diseases, has increased significantly, causing a serious threat to public health. This paper focuses on the epidemiology, clinical characteristics, especially laboratory diagnosis of insect-borne infectious diseases, and emphasizes that medical institutions should pay attention to the rapid and accurate laboratory diagnosis of insect-borne infectious diseases. Metagenomic next generation sequencing has potential value in the diagnosis of insect-borne infectious diseases with unknown causes.

Severe dengue associated with Staphylococcus aureus sepsis in pediatric patients: a case series.

BACKGROUND: Staphylococcus aureus co-infection is seldom reported in children with severe dengue. METHODOLOGY: In this retrospective study, we reported five children with severe dengue and S. aureus co-infection admitted to pediatric intensive care unit (PICU) during July-December 2021. RESULTS: All children had prolonged fever, persistence of bilateral pleural effusion beyond the critical phase, thrombocytopenia and raised inflammatory markers [C-reactive protein (CRP) and procalcitonin]. S. aureus was isolated from pleural fluid (n = 2, 40%), blood (n = 2, 40%) and endotracheal aspirate (n = 1, 20%). Four children (80%) grew methicillin-sensitive S. aureus, while 1 (20%) had methicillin-resistant S. aureus. Two children (40%) had septic thromboemboli in skin, and 1 (20%) had limb cellulitis. One child required anterior thoracotomy, pericardiectomy and bilateral pleural decortication, while all other children required intercostal chest tube drainage. All children required prolonged targeted antibiotics, invasive mechanical ventilation and had prolong stay in PICU and all of them survived. CONCLUSION: In children with severe dengue, persistence of fever, persistence of pleural effusion beyond critical phase and raised CRP and procalcitonin should raise suspicion of bacterial/S. aureus co-infection.

Assessment of Post-Dengue Rheumatic Symptoms Using the WOMAC and DAS-28 Questionnaires in a Honduran Population after a Four-Month Follow-Up.

Introduction: Alphaviruses may cause arthritis, but there is a lack of studies assessing it in flaviviruses such as dengue. Through the 28 Joint Disease Activity Score (DAS-28), incorporating swollen joint counts, and through the Arthritis Index from Western Ontario and McMaster Universities (WOMAC), we assessed pain, stiffness, and dimensions of arthritic function in post-DENV patients. Methods: Prospective study of a cohort of participants who were diagnosed with dengue in centres in Honduras from December 2019 to February 2020, with a follow-up period of 4 months to evaluate post-dengue rheumatological disease through the WOMAC and DAS-28 questionnaires. Results: After a four-month follow-up phase with 281 participants, the final cohort comprised 58.8% women and 41.20% men. After the follow-up, 63.02% persisted with the clinical findings. According to WOMAC, joint involvement was higher in women with (58.76%) (p < 0.0001) these symptoms or functional limitations when performing daily activities were limited to pain when walking (34.81% vs. 5.51%), climbing or descending stairs (36.46% vs. 8.66%), and at night at bedtime (28.73% vs. 7.08%). With the DAS-28, we found at least one alteration with inflammation or pain in 14.91% of the participants, primarily women (p < 0.01). Discussion: Joint involvement was high during the dengue epidemic in 2019. We observed a significant proportion of women with inflammation and joint pain, showing that dengue may lead to the development of chronic rheumatological findings, although lower than in CHIKV, still affecting everyday life and, consequently, their quality of life. Additional long-term evaluation studies after dengue are required.