Investigação do surto de infecções por arbovirus em Tuparetama, Pernambuco
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Data
2018-05-24
Autores
Farias, Rodrigo Pessoa de [UNIFESP]
Orientadores
Sanabani, Sabri Saeed Mohammed Ahmed Al [UNIFESP]
Tipo
Tese de doutorado
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Em abril de 2015, ocorreu um surto de uma doença semelhante a dengue em Tuparetama, pequena cidade na região nordeste do Brasil; este surto foi caracterizado por sua rápida expansão. Iniciou-se uma investigação para identificar as etiologias virais e aconselhar as autoridades sanitárias na implementação de medidas de controle para conter o foco. Este é o primeiro relatório deste surto no Nordeste, embora alguns casos tenham sido documentados anteriormente em uma cidade vizinha. Foram obtidas amostras de 77 pacientes com suspeita de dengue que foram atendidos no principal hospital da cidade. Os ensaios de laboratório, como a reação em cadeia da polimerase de transcrição reversa em tempo real, o sequenciamento do cDNA do vírus e o ensaio de imunoabsorção enzimática, foram utilizados para identificação viral. A análise filogenética molecular foi realizada para definir os genótipos virais circulantes. O RNA do vírus Zika (ZIKV) e Dengue (DENV) ou anticorpos IgM (Abs) para DENV ou chikungunya (CHIKV) foram detectados em 40 das 77 amostras de plasma (51,9%). DENV foi encontrado em 9 pacientes (11,7%), ZIKV foi encontrado em 31 pacientes (40,2%), CHIKV em 1 paciente (1,3%) coinfecção de DENV e ZIKV foi detectado em 2 pacientes (2,6%). Foram relatadas ainda as vantagens de testes para o vírus Zika (ZIKV) na urina, devido a excreção viral que pode durar até 20 dias após o início da doença. Nós investigamos 61 pacientes nos primeiros 5 dias após o início dos sintomas e encontramos mais pacientes positivos para ZIKV em amostras de plasma (n = 46), do que em amostras de urina (n = 37). Para os pacientes, que apresentaram positividade para ZIKV tanto no plasma quanto em urina (n = 28), as cargas virais foram similares em ambos materiais biológicos. Nas análises filogenéticas observamos que as 2 sequências de DENV pertenciam ao genótipo 1 e as 14 ZIKV sequencias parciais analisadas demonstraram similaridade com a linhagem asiática. Nossos resultados mostraram que o surto em curso foi causado por ZIKV, DENV e CHIKV. Isso enfatiza a necessidade de um diagnóstico rotineiro e diferencial de arbovírus em pacientes com sintomas semelhantes a dengue.
In April 2015, an outbreak of dengue-like illness occurred in Tuparetama, a small city in the northeast region of Brazil; this outbreak was characterized by its fast expansion. An investigation was initiated to identify the viral etiologies and advise the health authorities on implementing control measures to contain the outbreak. This is the first report of this outbreak in the northeast, even though a few cases were documented earlier in a neighboring city.Plasma samples were obtained from 77 suspected dengue patients attending the main hospital in the city. Laboratory assays, such as real-time reverse transcription polymerase chain reaction, virus cDNA sequencing, and enzyme-linked immunosorbent assay, were employed to identify the infecting virus and molecular phylogenetic analysis was performed to define the circulating viral genotypes.RNA of Zika virus (ZIKV) and Dengue virus (DENV) or IgM antibodies (Abs) to DENV or chikungunya (CHIKV) were detected in 40 of the 77 plasmas samples (51.9%). DENV was found in 9 patients (11.7%), ZIKV was found in 31 patients (40.2%), CHIKV in 1 patient (1.3%), and coinfection of DENV and ZIKV was detected in 2 patients (2.6%). Advantages of testing for Zika virus (ZIKV) in urine have been reported, such as the persistence of ZIKV in this type of specimen for up to 20 days after ZIKV disease onset. We investigate 61 patients in the first 5 days post-symptom onset and find more patients testing positive for ZIKV in plasma samples (n=46), than in corresponding urine samples (n=37). For patients respectively testing positive in both plasma and urine (n=28), respective viral loads appeared similar. The phylogenetic analysis of 2 available partial DENV and 14 ZIKV sequences revealed the identities of genotype 1 and the Asiatic lineage, respectively.Consistent with recent reports from the same region; our results showed that the ongoing outbreak is caused by ZIKV, DENV, and CHIKV. This emphasizes the need for a routine and differential diagnosis of arboviruses in patients with dengue-like illness.
In April 2015, an outbreak of dengue-like illness occurred in Tuparetama, a small city in the northeast region of Brazil; this outbreak was characterized by its fast expansion. An investigation was initiated to identify the viral etiologies and advise the health authorities on implementing control measures to contain the outbreak. This is the first report of this outbreak in the northeast, even though a few cases were documented earlier in a neighboring city.Plasma samples were obtained from 77 suspected dengue patients attending the main hospital in the city. Laboratory assays, such as real-time reverse transcription polymerase chain reaction, virus cDNA sequencing, and enzyme-linked immunosorbent assay, were employed to identify the infecting virus and molecular phylogenetic analysis was performed to define the circulating viral genotypes.RNA of Zika virus (ZIKV) and Dengue virus (DENV) or IgM antibodies (Abs) to DENV or chikungunya (CHIKV) were detected in 40 of the 77 plasmas samples (51.9%). DENV was found in 9 patients (11.7%), ZIKV was found in 31 patients (40.2%), CHIKV in 1 patient (1.3%), and coinfection of DENV and ZIKV was detected in 2 patients (2.6%). Advantages of testing for Zika virus (ZIKV) in urine have been reported, such as the persistence of ZIKV in this type of specimen for up to 20 days after ZIKV disease onset. We investigate 61 patients in the first 5 days post-symptom onset and find more patients testing positive for ZIKV in plasma samples (n=46), than in corresponding urine samples (n=37). For patients respectively testing positive in both plasma and urine (n=28), respective viral loads appeared similar. The phylogenetic analysis of 2 available partial DENV and 14 ZIKV sequences revealed the identities of genotype 1 and the Asiatic lineage, respectively.Consistent with recent reports from the same region; our results showed that the ongoing outbreak is caused by ZIKV, DENV, and CHIKV. This emphasizes the need for a routine and differential diagnosis of arboviruses in patients with dengue-like illness.
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Citação
FARIAS, Rodrigo Pessôa de. Investigação do surto de infecções por arbovirus em Tuparetama, Pernambuco. 2018. 54 f. Tese (Doutorado em Medicina translacional) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2018.