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BACKGROUND: The public health impact of the coronavirus disease 2019 (COVID-19) pandemic has motivated a rapid search for potential therapeutics, with some key successes. However, the potential impact of different treatments, and consequently research and procurement priorities, have not been clear. METHODS: Using a mathematical model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, COVID-19 disease and clinical care, we explore the public-health impact of different potential therapeutics, under a range of scenarios varying healthcare capacity, epidemic trajectories; and drug efficacy in the absence of supportive care. RESULTS: The impact of drugs like dexamethasone (delivered to the most critically-ill in hospital and whose therapeutic benefit is expected to depend on the availability of supportive care such as oxygen and mechanical ventilation) is likely to be limited in settings where healthcare capacity is lowest or where uncontrolled epidemics result in hospitals being overwhelmed. As such, it may avert 22% of deaths in high-income countries but only 8% in low-income countries (assuming Râ =â 1.35). Therapeutics for different patient populations (those not in hospital, early in the course of infection) and types of benefit (reducing disease severity or infectiousness, preventing hospitalization) could have much greater benefits, particularly in resource-poor settings facing large epidemics. CONCLUSIONS: Advances in the treatment of COVID-19 to date have been focused on hospitalized-patients and predicated on an assumption of adequate access to supportive care. Therapeutics delivered earlier in the course of infection that reduce the need for healthcare or reduce infectiousness could have significant impact, and research into their efficacy and means of delivery should be a priority.
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Tratamento Farmacológico da COVID-19 , SARS-CoV-2 , Efeitos Psicossociais da Doença , Humanos , Pandemias/prevenção & controle , Preparações FarmacêuticasRESUMO
Herein, we report a case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and dengue coinfection, presented as a fatal stroke in our hospital, in São José do Rio Preto, São Paulo State, a Brazilian city hyperendemic for dengue viruses and other arthropod-borne viruses (arboviruses) and currently facing a surge of SARS-CoV-2 cases. This case is the first described in the literature and contributes to the better understanding of clinical presentations of two important diseases in a tropical setting.
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COVID-19/complicações , Coinfecção/complicações , Vírus da Dengue/patogenicidade , Dengue/complicações , SARS-CoV-2/patogenicidade , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/virologia , Arbovírus/patogenicidade , Brasil , COVID-19/virologia , Coinfecção/virologia , Dengue/virologia , Feminino , Humanos , Pessoa de Meia-IdadeAssuntos
Infecção por Zika virus/epidemiologia , Zika virus , Humanos , Pandemias , Prevalência , Porto RicoRESUMO
Background: Dengue cases can progress to severe ant life-threating forms particularly in subsequent heterologous infections. However, recent studies had explored additional risk factors, including underlying health conditions, even in individuals without prior exposure to dengue, notably, in patients with endothelial dysfunction and chronic inflammation. This study examines the link between diabetes and the development of severe dengue disease in dengue-naive patients during the 2019 dengue outbreak in São Jose do Rio Preto, Brazil. Methodology: We enrolled 529 laboratory-confirmed dengue cases, identified through DENV RT-PCR or NS1 antigen assays in a hospital cohort of acute febrile illness. Subsequently, we investigated the presence of anti-dengue and anti-Zika IgG antibodies. Samples testing positive for Zika were excluded from the analyses. Two groups were analyzed: naïve (DV-), and dengue history (DV+). Results: Initially, presence of diabetes and kidney disease, as well as being dengue-naive, were associated with a higher frequency of severe and potentially severe clinical outcomes. Multivariate analysis identified diabetes as a risk factor, while the presence of anti-dengue antibodies was considered protective. Analysis of dengue naïve samples, highlighted diabetes as an independent risk factor to severe forms of dengue disease. In DV+ patients, no condition was highlighted as a risk factor by univariate analysis or multivariate analysis. Conclusions: We investigated and confirmed diabetes as a risk factor for severe dengue disease in individuals without prior dengue or Zika exposure. Our conclusions raise significant concerns given diabetes' ever increasing global prevalence and its potential impact on patients with or previous dengue exposure.
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Madariaga virus (MADV) and Venezuelan equine encephalitis virus (VEEV) are emerging arboviruses affecting rural and remote areas of Latin America. However, there are limited clinical and epidemiological reports available, and outbreaks are occurring at an increasing frequency. We addressed this gap by analyzing all the available clinical and epidemiological data of MADV and VEEV infections recorded since 1961 in Panama. A total of 168 of human alphavirus encephalitis cases were detected in Panama from 1961 to 2023. Here we describe the clinical signs and symptoms and epidemiological characteristics of these cases, and also explored signs and symptoms as potential predictors of encephalitic alphavirus infection when compared to those of other arbovirus infections occurring in the region. Our results highlight the challenges clinical diagnosis of alphavirus disease in endemic regions with overlapping circulation of multiple arboviruses.
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Lower respiratory tract infections (LRIs) are a significant cause of disability-adjusted life-years (DALYs) across all age groups, especially in children under 9 years of age, and adults over 75. The main causative agents are viruses, such as influenza and respiratory syncytial virus (RSV). Viral LRIs in adults have historically received less attention. This study investigated the incidence of RSV and influenza in adult patients admitted to a referral hospital, as well as the clinical profile of these infections. Molecular testing was conducted on nasopharyngeal samples taken from a respiratory surveillance cohort comprising adult (15-59 years) and elderly (60+ years) hospitalized patients who tested negative for SARS-CoV-2, to determine the prevalence for influenza and RSV. Influenza was found to be less frequent among the elderly. The main symptoms of RSV infections were cough, fever, dyspnea, malaise, and respiratory distress, while headache, nasal congestion, a sore throat, and myalgia were most frequent in influenza. Elderly patients with RSV were not found to have more severe illness than adults under age 60, underscoring the importance of providing the same care to adults with this viral infection.
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COVID-19 , Influenza Humana , Infecções por Vírus Respiratório Sincicial , Vírus Sincicial Respiratório Humano , Criança , Idoso , Adulto , Humanos , Pessoa de Meia-Idade , Infecções por Vírus Respiratório Sincicial/epidemiologia , Doenças Negligenciadas , Influenza Humana/epidemiologia , SARS-CoV-2RESUMO
Carbapenemase-producing Klebsiella pneumoniae (CPKp) infections are important threats to pediatric populations. Thus, a retrospective study was conducted in a Brazilian reference pediatric hospital, and 26 CPKp isolates obtained from 23 patients were characterized. The affected population had important underlying diseases, reflecting previous hospitalization and antibiotic use. Most CPKp isolates were resistant to all antibiotic classes, and blaKPC-2 was the only carbapenemase-encoding gene. blaCTX-M-15 was common among the isolates, and modification or absence of the mgrB gene was the cause of polymyxin B resistance. Ten different sequence types were identified, and clonal complex 258 was prevalent. Alleles wzi50 and wzi64 were the most recurrent ones regarding K-locus type, with a remarkable contribution of the epidemic ST11/KL64 lineage as a colonizer. Our findings show that lineages associated with the pediatric population are similar to those found in adults, reinforcing the need for epidemiological surveillance to effectively implement prevention and control measures.
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Enterobacteriáceas Resistentes a Carbapenêmicos , Infecções por Klebsiella , beta-Lactamases , Adulto , Criança , Humanos , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , beta-Lactamases/genética , Brasil/epidemiologia , Hospitais Pediátricos , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/genética , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Estudos RetrospectivosRESUMO
Dengue is a serious mosquito-transmitted disease caused by the dengue virus (DENV). Rapid and reliable diagnosis of DENV infection is urgently needed in dengue-endemic regions. We describe here the performance evaluation of the CE-marked VIDAS® dengue immunoassays developed for the automated detection of DENV NS1 antigen and anti-DENV IgM and IgG antibodies. A multicenter concordance study was conducted in 1296 patients from dengue-endemic regions in Asia, Latin America, and Africa. VIDAS® dengue results were compared to those of competitor enzyme-linked immunosorbent assays (ELISA). The VIDAS® dengue assays showed high precision (CV ≤ 10.7%) and limited cross-reactivity (≤15.4%) with other infections. VIDAS® DENGUE NS1 Ag showed high positive and negative percent agreement (92.8% PPA and 91.7% NPA) in acute patients within 0-5 days of symptom onset. VIDAS® Anti-DENGUE IgM and IgG showed a moderate-to-high concordance with ELISA (74.8% to 90.6%) in post-acute and recovery patients. PPA was further improved in combined VIDAS® NS1/IgM (96.4% in 0-5 days acute patients) and IgM/IgG (91.9% in post-acute patients) tests. Altogether, the VIDAS® dengue NS1, IgM, and IgG assays performed well, either alone or in combination, and should be suitable for the accurate diagnosis of DENV infection in dengue-endemic regions.
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BACKGROUND: The co-circulation of flaviviruses in tropical regions has led to the hypothesis that immunity generated by a previous dengue infection could promote severe disease outcomes in subsequent infections by heterologous serotypes. This study investigated the influence of antibodies generated by previous Zika infection on the clinical outcomes of dengue infection. METHODOLOGY/PRINCIPAL FINDINGS: We enrolled 1,043 laboratory confirmed dengue patients and investigated their prior infection to Zika or dengue. Severe forms of dengue disease were more frequent in patients with previous Zika infection, but not in those previously exposed to dengue. CONCLUSIONS/SIGNIFICANCE: Our findings suggest that previous Zika infection may represent a risk factor for subsequent severe dengue disease, but we did not find evidence of antibody-dependent enhancement (higher viral titer or pro-inflammatory cytokine overexpression) contributing to exacerbation of the subsequent dengue infection.
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Vírus da Dengue , Dengue , Infecção por Zika virus , Zika virus , Humanos , Anticorpos Antivirais , Reações CruzadasRESUMO
Arbovirus infections are increasingly important causes of disease, whose spectrum of neurological manifestations are not fully known. This study sought to retrospectively assess the incidence of arboviruses in cerebrospinal fluid samples of patients with neurological symptoms to inform diagnosis of central and peripheral nervous system disorders. A total of 255 cerebrospinal fluid (CSF) samples collected from January 2016 to December 2017 were tested for dengue virus (DENV 1-4), Zika virus (ZIKV), and Chikungunya virus (CHIKV) in addition to other neurotropic arboviruses of interest, using genetic and serologic assays. Of the 255 CSF samples analyzed, 3.53% (09/255) were positive for arboviruses presenting mainly as meningitis, encephalitis, and cerebrovascular events, of which ZIKV was detected in 2.74% (7/255), DENV in 0.78% (2/255), in addition to an identified ILHV infection that was described previously. All the cases were detected in adults aged 18 to 74 years old. Our findings highlight the scientific and clinical importance of neurological syndromes associated with arboviruses and demonstrate the relevance of specific laboratory methods to achieve accurate diagnoses as well as highlight the true dimension of these diseases to ultimately improve public health planning and medical case management.
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Infecções por Arbovirus , Arbovírus , Febre de Chikungunya , Dengue , Doenças do Sistema Nervoso , Infecção por Zika virus , Zika virus , Adolescente , Adulto , Idoso , Infecções por Arbovirus/epidemiologia , Arbovírus/genética , Brasil/epidemiologia , Humanos , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/epidemiologia , Estudos Retrospectivos , Adulto Jovem , Zika virus/genéticaRESUMO
BACKGROUND: This study evaluated the galectin-1 and -3 expression during N-methyl-N'-nitro-N-nitrosoguanidine (MNNG)-induced gastric carcinogenesis in denervated rat stomachs using benzalkonium chloride. METHOD: Four experimental situations were evaluated: nondenervated and denervated stomachs without lesions and nondenervated and denervated stomachs with lesions. Sections of the pyloric region were stained with toluidine blue and incubated with mouse monoclonal anti-Gal-1 and rabbit polyclonal anti-Gal-3 for histopathological and immunohistochemical analysis, respectively. RESULT: MNNG caused the development of benign and malignant epithelial lesions, which were more pronounced in nondenervated stomachs with lesions and accompanied by inflammatory cell-enriched stroma. By immunostaining, the epithelial cells, blood vessels, muscle layer, and myenteric plexus were Gal-1 and -3 positive. Gal-3 was also detected in the gastric crypts, mucus secretion, and fibroblasts of pyloric fragments. Development of lesions in denervated stomachs was associated with a significant decrease in Gal-1 and -3 expression in epithelial cells, mast cells, and neutrophil cytoplasm, compared with that of nondenervated stomach lesions (P < 0.01; P < 0.001; P < 0.001, respectively). CONCLUSION: These results demonstrate that myenteric denervation downregulates endogenous Gal-1 and -3 expression, which might inhibit tumor development in this experimental model.
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Galectina 1/metabolismo , Galectina 3/metabolismo , Neoplasias Gástricas/induzido quimicamente , Neoplasias Gástricas/metabolismo , Adenocarcinoma/metabolismo , Animais , Denervação , Regulação para Baixo , Sistema Nervoso Entérico , Galectina 1/genética , Galectina 3/genética , Regulação Neoplásica da Expressão Gênica , Masculino , Metilnitronitrosoguanidina/toxicidade , Neoplasias Experimentais , Ratos , Ratos WistarRESUMO
The rapid development of efficacious and safe vaccines against coronavirus disease 2019 (COVID-19) has been instrumental in mitigating the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Moreover, the emergence of SARS-CoV-2 variants raised concerns on the efficacy of these vaccines. Herein, we report two cases of breakthrough infections with the P1 variant in patients vaccinated with CoronaVac, which is one of the two vaccines authorized for emergency use in the Brazilian immunization program. Our observations suggest that the vaccine reduced the severity of the disease and highlight the potential risk of illness following vaccination and subsequent infection with the P1 variant as well as for continued efforts to prevent and diagnose infection in vaccinated persons.
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Anticorpos Antivirais/sangue , Vacinas contra COVID-19/imunologia , COVID-19/diagnóstico por imagem , COVID-19/imunologia , SARS-CoV-2/imunologia , Vacinação/efeitos adversos , Brasil , COVID-19/prevenção & controle , Teste de Ácido Nucleico para COVID-19 , Vacinas contra COVID-19/administração & dosagem , Ensaios Clínicos como Assunto , Dexametasona/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/genética , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Vacinação/estatística & dados numéricos , Tratamento Farmacológico da COVID-19RESUMO
The Zika virus (ZIKV) epidemic in Brazil occurred in regions where dengue viruses (DENV) are historically endemic. We investigated the differences in adverse pregnancy/infant outcomes in two cohorts comprising 114 pregnant women with PCR-confirmed ZIKV infection in Rio de Janeiro, Southeastern Brazil (n = 50) and Manaus, in the north region of the country (n = 64). Prior exposure to DENV was evaluated through plaque reduction neutralizing antibody assays (PRNT 80) and DENV IgG serologies. Potential associations between pregnancy outcomes and Zika attack rates in the two cities were explored. Overall, 31 women (27%) had adverse pregnancy/infant outcomes, 27 in Rio (54%) and 4 in Manaus (6%), p < 0.001. This included 4 pregnancy losses (13%) and 27 infants with abnormalities at birth (24%). A total of 93 women (82%) had evidence of prior DENV exposure, 45 in Rio (90%) and 48 in Manaus (75%). Zika attack rates differed; the rate in Rio was 10.28 cases/10,000 and in Manaus, 0.6 cases/10,000, p < 0.001. Only Zika attack rates (Odds Ratio: 17.6, 95% Confidence Interval 5.6-55.9, p < 0.001) and infection in the first trimester of pregnancy (OR: 4.26, 95% CI 1.4-12.9, p = 0.011) were associated with adverse pregnancy and infant outcomes. Pre-existing immunity to DENV was not associated with outcomes (normal or abnormal) in patients with ZIKV infection during pregnancy.
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Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/virologia , Zika virus , Adulto , Anticorpos Antivirais , Brasil/epidemiologia , Estudos de Coortes , Coinfecção , Dengue/diagnóstico , Dengue/epidemiologia , Dengue/virologia , Feminino , Avaliação do Impacto na Saúde , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Prevalência , Vigilância em Saúde Pública , Fatores de Risco , Adulto Jovem , Zika virus/imunologia , Infecção por Zika virus/diagnósticoRESUMO
BACKGROUND: In this study the effect of myenteric denervation induced by benzalconium chloride (BAC) on distribution of fibrillar components of extracellular matrix (ECM) and inflammatory cells was investigated in gastric carcinogenesis induced by N-methyl-N'-nitro-N-nitrosoguanidine (MNNG). Rats were divided in four experimental groups: non-denervated (I) and denervated stomach (II) without MNNG treatment; non-denervated (III) and denervated stomachs (IV) treated with MNNG. For histopathological, histochemical and stereological analysis, sections of gastric fragments were stained with Hematoxylin-Eosin, Picrosirius-Hematoxylin, Gomori reticulin, Weigert's Resorcin-Fuchsin, Toluidine Blue and Alcian-Blue/Safranin (AB-SAF). RESULTS: BAC denervation causes an increase in the frequency of reticular and elastic fibers in the denervated (group II) compared to the non-denervated stomachs (group I). The treatment of the animals with MNNG induced the development of adenocarcinomas in non-denervated and denervated stomachs (groups III and IV, respectively) with a notable increase in the relative volume of the stroma, the frequency of reticular fibers and the inflammatory infiltrate that was more intense in group IV. An increase in the frequency of elastic fibers was observed in adenocarcinomas of denervated (group IV) compared to the non-denervated stomachs (group III) that showed degradation of these fibers. The development of lesions (groups III and IV) was also associated with an increase in the mast cell population, especially AB and AB-SAF positives, the latter mainly in the denervated group IV. CONCLUSIONS: The results show a strong association in the morphological alteration of the ECM fibrillar components, the increased density of mast cells and the development of tumors induced by MNNG in the non-denervated rat stomach or denervated by BAC. This suggests that the study of extracellular and intracellular components of tumor microenvironment contributes to understanding of tumor biology by action of myenteric denervation.
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Ilheus virus is an arbovirus with the potential for central nervous system involvement. Accurate diagnosis is a challenge due to similar clinical symptoms and serologic cross-reactivity with other flaviviruses. Here, we describe the first documented case of a fatal outcome following the identification of Ilheus virus in the cerebrospinal fluid (CSF) of a patient with cerebral encephalitis in Brazil.
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Encefalite/mortalidade , Encefalite/virologia , Flavivirus/isolamento & purificação , Idoso , Encéfalo/diagnóstico por imagem , Brasil , Líquido Cefalorraquidiano/virologia , Encefalite/líquido cefalorraquidiano , Encefalite/diagnóstico por imagem , Evolução Fatal , Flavivirus/classificação , Flavivirus/genética , Humanos , Masculino , FilogeniaRESUMO
Arthropod-borne viruses (arboviruses) of the genus Flavivirus are distributed globally and cause significant human disease and mortality annually. Flavivirus infections present a spectrum of clinical manifestations, ranging from asymptomatic to severe manifestations, including hemorrhage, encephalitis and death. Herein, we describe 3 case reports of cerebrovascular involvement in patients infected by dengue and Zika viruses in Sao Jose do Rio Preto, São Paulo State, Brazil, a hyperendemic area for arbovirus circulation, including dengue, yellow fever, chikungunya and Saint Louis encephalitis viruses. Our findings highlight the potential threat that unusual clinical manifestations may pose to arbovirus disease management and recovery.
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Transtornos Cerebrovasculares/patologia , Transtornos Cerebrovasculares/virologia , Dengue/patologia , Doenças do Sistema Nervoso/patologia , Doenças do Sistema Nervoso/virologia , Infecção por Zika virus/patologia , Adulto , Idoso , Brasil , Vírus da Dengue/isolamento & purificação , Feminino , Humanos , Masculino , Zika virus/isolamento & purificaçãoRESUMO
BACKGROUND: The recent introduction of new arboviruses in the Americas, as Zika virus (ZIKV) and Chikungunya virus (CHIKV), increased the risk of outbreaks and arboviral co-infections. Herein, we report twelve cases of co-infection of ZIKV and different DENV serotypes in a city located in the northwest region of São Paulo State, Brazil, which is hyper-endemic to Dengue. METHODS: Between January and November 2016, 1254 suspected cases of arboviral infection were available by our surveillance program in São José do Rio Preto. All suspected patients were examined and, when they were arboviral disease-suspectd, had sera separated and viral RNA analyzed by PCR/qPCR assays to determine the diagnosis of DENV 1-4, ZIKV, or CHIKV in the same samples. After the molecular results, twelve patients with ZIKV-DENV coinfection were identified and their clinical and laboratory characteristics were described. RESULTS: The mean between symptoms onset and collected sample of 3 days. DENV-1 was identified in seven co-infected patients and DEN2 in other five. Two patients presented alarm signs of Dengue and no one was hospitalized. CONCLUSIONS: The constant presence of co-circulating arboviruses increases the chance of co-infection and demonstrates the importance of the differential diagnosis, especially during periods of arboviral outbreaks. The impact of this co-infection is known individual and collectively.
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Coinfecção/epidemiologia , Vírus da Dengue/classificação , Dengue/epidemiologia , Surtos de Doenças , Sorogrupo , Infecção por Zika virus/epidemiologia , Adulto , Brasil/epidemiologia , Vírus Chikungunya/isolamento & purificação , Coinfecção/patologia , Coinfecção/virologia , Dengue/patologia , Dengue/virologia , Vírus da Dengue/isolamento & purificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , RNA Viral/genética , RNA Viral/isolamento & purificação , Zika virus/isolamento & purificação , Infecção por Zika virus/patologia , Infecção por Zika virus/virologiaRESUMO
This study evaluated the properties of endogenous nitric oxide synthases (NOS) and annexin-A1 (ANXA1) and determined how they can be exploited in the N-methyl-N-nitro-N-nitrosoguanidine (MNNG)-induced gastric carcinogenesis and myenteric denervation model. Male Wistar rats were treated with MNNG and/or aminoguanidine (AG) for 20 weeks. In another set of experiments, rats with nondenervated and denervated stomachs were treated with MNNG or water for 28 weeks. Fragments of the pyloric region were processed for histopathology, NOS activity, and immunohistochemistry to explore the activity and expression of constitutive (cNOS) and inducible (iNOS) NO synthase and their relationship with annexin-A1 (ANXA1) expression. NO inhibition by AG increased the percentage of animals with adenocarcinomas (~29%) compared with the untreated MNNG group (~4%). Myenteric denervation did not alter NOS activity. cNOS activity was significantly greater in nondernervated and denervated stomachs with or without lesions (P<0.001) than iNOS activity (P<0.01), as confirmed by immunohistochemistry. Further, cNOS activity in normal stomachs and outside the lesion area was considerably higher than inside it (P<0.01). By densitometric analysis of nondenervated and denervated stomachs, ANXA1 expression was modulated in epithelial and inflammatory cells (mast cells and neutrophils), wherein significant alterations were induced by lesion development and myenteric denervation. In conclusion, NO protects against the development of gastric adenocarcinomas. The pattern of ANXA1 expression was not associated with NOS activity or expression, suggesting that NO and ANXA1 act in gastric tumors in disparate pathways.