Análise da prevalência de internações por dengue no estado do Tocantins entre 2017 e 2022 / The prevalence of hospitalizations and deaths for dengue in the state of Tocantins between 2017 and 2022 / Prevalencia de hospitalizaciones y muertes por dengue en el estado de Tocantins entre 2017 y 2022

O Tocantins é um Estado endêmico para dengue devido aos elevados índices pluviométricos e do saneamento básico escasso. Esta pesquisa objetivou investigar o número de internações por dengue no Estado do Tocantins entre 2017 e 2022. O estudo consiste em um delineamento transversal retrospectivo quantitativo, realizado a partir de dados coletados no Tabnet/DataSUS. Os resultados encontrados foram compilados no programa Microsoft Excel®, e por meio de gráficos e tabelas, foram evidenciados 28.355 casos de dengue confirmados, dos quais apenas 1.798 (6%) necessitaram de hospitalizações, com maior incidência em 2019, tendo Palmas como município mais acometido. Conclui-se, portanto, que a dengue segue sendo uma doença prevalente no Estado, de modo a demandar atenção de gestores de saúde com vistas a reduzir os números altos de casos por meio de vigilância epidemiológica ativa como, também, fornecer o melhor cuidado para os pacientes diagnosticados com dengue, quer seja no âmbito ambulatorial quer no hospitalar.

Tocantins is an endemic state for dengue due to high rainfall rates and poor sanitation. This research aimed to investigate the number of dengue hospitalizations in the State of Tocantins between 2017 and 2022. The study consists of a retrospective quantitative cross-sectional design, performed from data collected in Tabnet/DataSUS. The results found were compiled in Microsoft Excel® program, and by means of graphs and tables, 28,355 confirmed dengue cases were evidenced, of which only 1,798 (6%) required hospitalizations, with a higher incidence in 2019, with Palmas as the most affected municipality. It is concluded, therefore, that dengue remains a prevalent disease in the state, so as to demand attention from health managers with a view to reducing the high numbers of cases through active epidemiological surveillance as well as providing the best care for patients diagnosed with dengue, whether in the outpatient or hospital setting.

Tocantins es un estado endémico para el dengue debido a las altas tasas de precipitación y al saneamiento deficiente. Esta investigación tuvo como objetivo investigar el número de hospitalizaciones por dengue en el Estado de Tocantins entre 2017 y 2022. El estudio consiste en un diseño cuantitativo transversal retrospectivo, realizado a partir de datos recogidos en Tabnet/DataSUS. Los resultados encontrados fueron compilados en el programa Microsoft Excel®, y por medio de gráficos y tablas, se evidenciaron 28.355 casos confirmados de dengue, de los cuales sólo 1.798 (6%) requirieron hospitalizaciones, con mayor incidencia en 2019, siendo Palmas el municipio más afectado. Se concluye, por lo tanto, que el dengue continúa siendo una enfermedad prevalente en el estado, por lo que demanda la atención de los gestores de salud con miras a reducir las altas cifras de casos a través de la vigilancia epidemiológica activa, así como brindar la mejor atención a los pacientes diagnosticados con dengue, ya sea en el ámbito ambulatorio u hospitalario.

Manifestaciones oftalmológicas del dengue, el zika y el chikungunya / Ophthalmic manifestations of dengue, zika and chikungunya

Las infecciones por arbovirus constituyen un reto significativo para los sistemas de salud. Cada vez se incrementa el reconocimiento de complicaciones del sistema nervioso central secundarias a ellas, lo que puede ser un dilema para su diagnóstico y tratamiento. Los arbovirus pueden alterar los mecanismos de inmunidad innatos del ojo al dañar las barreras óculo-hemáticas. En esta revisión nos propusimos caracterizar los principales hallazgos oftalmológicos de las enfermedades transmitidas por mosquito, como el dengue, el zika y el chikungunya, y su posible fisiopatología. Se realizó una búsqueda de la literatura sobre el tema en la base de datos de PubMED. En los pacientes con zika y chikungunya se reconocieron frecuentemente la conjuntivitis no purulenta y la queratitis. En los casos de dengue el edema macular y las hemorragias retinianas maculares fueron frecuentes; causaron disminución de la visión y defectos campimétricos; la vasculitis y coriorretinitis periférica podía ser asintomática si la mácula no estaba comprometida. Estuvieron implicados la trombocitopenia y otros procesos fisiopatológicos. En las enfermedades estudiadas se reportaron casos raros con parálisis de nervios oculomotores o neuritis óptica como respuesta autoinmune tardía. Recientemente se reportó el síndrome de zika congénito que incluyó múltiples anomalías del desarrollo. En los neonatos afectados se describió la atrofia macular, así como la pigmentación macular bilateral, la hipoplasia del nervio óptico, la catarata, entre otros. Existen diversas lesiones oculares secundarias a infecciones por dengue, zika y chikungunya que merecen reconocimiento, pues deterioran la función visual temporal o permanentemente(AU)

Arbovirus infections pose a significant challenge to health systems. Awareness of the secondary central nervous system complications caused by these infections is on the increase, which may be a dilemma for their diagnosis and treatment. Arboviruses may alter the innate immunity mechanisms of the eye by damaging blood-retinal barriers. The objective of this review was to characterize the main ophthalmological findings of mosquito-borne diseases, such as dengue, zika and chikungunya, and their possible physiopathology. A bibliographic search about the topic was conducted in the database PubMed. Non-purulent conjunctivitis and keratitis were frequently found in zika and chikungunya patients. Dengue cases often presented macular edema and macular retinal hemorrhage, which caused vision reduction, as well as campimetric defects. Vasculitis and peripheral chorioretinitis could be asymptomatic if the macula was not involved. Thrombocytopenia and other physiopathological processes were also present. Oculomotor nerve palsy and optic neuritis as a late autoimmune response were rarely reported in the diseases studied. Recent reports refer to congenital zika syndrome, which causes multiple developmental abnormalities. Macular atrophy, bilateral macular pigmentation, optic nerve hypoplasia and cataract, among other disorders, were described in affected neonates. A variety of ocular lesions secondary to dengue, zika and chikungunya infection deserve recognition, for they damage visual function either temporarily or permanently(AU)

Validation of educational booklet: an educational technology in dengue prevention / Validación de cartilla educativa: una tecnología educacional en la prevención del dengue / Validação de cartilha educativa: uma tecnologia educacional na prevenção da dengue

ABSTRACT Objective: to validate a booklet on dengue prevention in order to make it an educational technology to be used with the population. Method: methodological study, carried out with two groups of judges specialized in health and other areas. For data analysis, the calculation of Content Validity Index was carried out. Results: the booklet, in general, was considered valid by the expert judges, since it obtained an overall CVI of 70%. However, it has undergone a textual and aesthetic re-elaboration. The changes were based on the substitution of expressions, phrases, information additions and language adequacy. The illustrations were redone, adding clarity, expressiveness, movement, interaction and contextualization. Conclusion: the booklet is valid to be used for the population, with the purpose of informing, in a playful way, the forms of prevention and combat to mosquito transmitting dengue.

RESUMEN Objetivo: validar una cartilla sobre prevención del dengue, con el fin de hacerla una tecnología educativa para ser utilizada con la población. Método: estudio metodológico, realizado con dos grupos de jueces especialistas de la Salud y de otras áreas. Para el análisis de los datos, se realizó el cálculo del Índice de Validez de Contenido. Resultados: se considera que la cartilla, en general, fue considerada válida por los jueces especialistas, ya que obtuvo un IVC global del 70%. Sin embargo, pasó por una reelaboración textual y estética. Los cambios recae sobre la sustitución de expresiones, frases, acrecimiento de informaciones y adecuación de lenguaje. Las ilustraciones fueron rehechas, añadiendo claridad, expresividad, movimiento, interacción y contextualización. Conclusión: la cartilla es válida para ser utilizada para la población, con el objetivo de informar, de manera lúdica, las formas de prevención y combate al mosquito transmisor del dengue.

RESUMO Objetivo: validar uma cartilha sobre prevenção da dengue, a fim de torná-la uma tecnologia educacional para ser utilizada com a população. Método: estudo metodológico, realizado com dois grupos de juízes especialistas da Saúde e de outras áreas. Para a análise dos dados, foi realizado o cálculo de Índice de Validade de Conteúdo. Resultados: a cartilha, em geral, foi considerada válida pelos juízes especialistas, visto que obteve um IVC global de 70%. Entretanto, passou por uma reelaboração textual e estética. As alterações recaíram sobre a substituição de expressões, frases, acréscimo de informações e adequação de linguagem. As ilustrações foram refeitas, acrescentando clareza, expressividade, movimento, interação e contextualização. Conclusão: a cartilha é válida a ser utilizada para a população, com o objetivo de informar, de maneira lúdica, as formas de prevenção e combate ao mosquito transmissor da dengue.

Clinical and epidemiological teaching of dengue through simulated practice / Enseñanza clínica y epidemiológica de dengue por medio de la práctica simulada / Ensino clínico e epidemiológico de dengue por meio da prática simulada

ABSTRACT Objective: to describe the experience of clinical teaching on dengue and the practice of epidemiological surveillance using problematization methodology. Method: report of experience on educational activity with undergraduate nursing students, held in March 2016, at a public university in the city of São Paulo, conceived in four stages: dialogic lecture, active search of Aedes aegypti, case study and simulation of nursing consultation to individuals with dengue. Results: The activity allowed to retrieve previous knowledge about the disease, respond to exercises that addressed different clinical situations and epidemiological surveillance, including in situ evaluation of possible mosquito outbreaks, and discuss the need to expand prevention and health of the individual and the community, the impact of the media in the dissemination of cases and the coping difficulties experienced in the different levels of attention. Conclusion: the methodology adopted enabled qualified training of students to cope with dengue.

RESUMEN Objetivo: describir la experiencia de enseñanza clínica sobre la dengue y la práctica de vigilancia epidemiológica utilizando metodología de la problematización. Método: relato de experiencia sobre actividad educativa con graduandos de Enfermería, realizada en marzo de 2016, en una universidad pública de la ciudad de São Paulo, concebida en cuatro etapas: clase expositiva dialogada, busca activa del Aedes aegypti, estudio de caso y simulación de consulta de enfermería a individuos con dengue. Resultados: La actividad permitió rescatar conocimientos previos sobre la enfermedad, responder a ejercicios que abordaban distintas situaciones clínicas y de vigilancia epidemiológica, incluyendo evaluación "in loco" de posibles focos del mosquito, y discutir la necesidad de ampliación de las acciones de prevención y promoción de la salud del individuo y colectividad, el impacto del medio de comunicación en la divulgación de los casos y las dificultades de enfrentamiento vividas en los diferentes niveles de atención. Conclusión: la metodología adoptada posibilitó capacitación cualificada de los alumnos para enfrentamiento de la dengue.

RESUMO Objetivo: descrever a experiência de ensino clínico sobre a dengue e a prática de vigilância epidemiológica utilizando metodologia da problematização. Método: relato de experiência sobre atividade educativa com graduandos de Enfermagem, realizada em março de 2016, em uma universidade pública da cidade de São Paulo, concebida em quatro etapas: aula expositiva dialogada, busca ativa do Aedes aegypti, estudo de caso e simulação de consulta de enfermagem a indivíduos com dengue. Resultados: A atividade permitiu resgatar conhecimentos prévios sobre a doença, responder a exercícios que abordavam distintas situações clínicas e de vigilância epidemiológica, incluindo avaliação "in loco" de possíveis focos do mosquito, e discutir a necessidade de ampliação das ações de prevenção e promoção da saúde do indivíduo e coletividade, o impacto da mídia na divulgação dos casos e as dificuldades de enfrentamento vivenciadas nos diferentes níveis de atenção. Conclusão: a metodologia adotada possibilitou capacitação qualificada dos alunos para enfrentamento da dengue.

Decrease in Dengue virus-2 infection and reduction of cytokine/chemokine production by Uncaria guianensis in human hepatocyte cell line Huh-7

ABSTRACT BACKGROUND Dengue fever may present hemorrhages and cavitary effusions as result of exacerbated immune responses. We investigated hydro-alcoholic extracts from leaves (UGL) and bark (UGB) of the medicinal species Uncaria guinanensis with respect to antiviral effects in Dengue virus (DENV) infection and in immunological parameters associated with in vivo physiopathological features. METHODS Chemical profiles from UGB or UGL were compared in thin layer chromatography and 1H nuclear magnetic resonance using flavonoid compounds and a pentacyclic oxindole alkaloid-enriched fraction as references. DENV-2-infected hepatocytes (Huh-7) were treated with extracts. Cell viability, DENV antigens and immunological factors were detected by enzyme-linked immunosorbent assay (ELISA) or flow cytometry. FINDINGS The UGL mainly differed from UGB by selectively containing the flavonoid kaempferitrin. UGB and UGL improved hepatocyte viability. Both extracts reduced intracellular viral antigen and inhibited the secretion of viral non-structural protein (NS1), which is indicative of viral replication. Reduction in secretion of macrophage migration inhibitory factor was achieved by UGB, of interleukin-6 by UGL, and of interleukin-8 by both UGB and UGL. MAIN CONCLUSIONS The U. guianensis extracts presented, antiviral and immunomodulatory effects for DENV and possibly a hepatocyte-protective activity. Further studies may be performed to consider these products as potential candidates for the development of an herbal product for the future treatment of dengue.

A systematic review of observational studies on oxidative/nitrosative stress involvement in dengue pathogenesis / Revisión sistemática de los estudios observacionales sobre el papel del estrés oxidativo-nitrosativo en la patogénesis del dengue

Objective: Our objective was to systematically review the published observational research related to the role of oxidative-nitrosative stress in pathogenesis of dengue. Methods: We searched electronic databases (PubMed, EMBASE, The COCHRANE library, ScienceDirect, Scopus, SciELO, LILACS via Virtual Health Library, Google Scholar) using the term: dengue, dengue virus, severe dengue, oxidative stress, nitrosative stress, antioxidants, oxidants, free radicals, oxidized lipid products, lipid peroxides, nitric oxide, and nitric oxide synthase. Articles were selected for review by title and abstract excluding letter, review, in vivo and in vitro studies, and duplicates studies. Selected articles were reviewed for study design, original purposes, sample size, main outcomes, methods, and oxidative-nitrosative stress markers values. Results: In total, 4,331 non-duplicates articles were identified from electronic databases searches, of which 16 were eligible for full text searching. Data from the observational studies originate from Asian countries (50%; 8/16), South American countries (31.2%; 5/16), and Central America and the Caribbean countries (18.8%; 3/16). Case-control study was the type of design most common in researches reviewed. The 1997 World Health Organization (WHO) dengue case classification criteria were used in all studies included in this review. Conclusions: Based on published data found in peer-reviewed literature, oxidative and nitrosative stress are demonstrated by changes in plasma levels of nitric oxide, antioxidants, lipid peroxidation and protein oxidation markers in patients with dengue infection. Additionally, elevated serum protein carbonyls and malondialdehyde levels appear to be associated with dengue disease severity.

Objetivo: Sistematizar las evidencias observacionales sobre la relación entre el estrés oxidativo-nitrosativo y la patogénesis del dengue. Métodos: Revisión sistemática de estudios observacionales en las bases de datos (PubMed, EMBASE, The COCHRANE library, ScienceDirect, Scopus, SciELO, LILACS via Virtual Health Library, Google Scholar) utilizando las siguientes palabras clave: dengue, dengue virus, severe dengue, oxidative stress, nitrosative stress, antioxidants, oxidants, free radicals, oxidized lipid products, lipid peroxides, nitric oxide y nitric oxide synthase. La selección inicial fue realizada a partir del título y resumen excluyéndose: cartas para editor, revisiones, estudios in vivo/in vitro y duplicados. A cada artículo seleccionado, se le revisó el diseño del estudio, objetivo, tamaño de la muestra, resultados principales y niveles plasmáticos de los marcadores de estrés oxidativo-nitrosativo. Resultados: De 4,331 publicaciones encontradas, 16 estudios cumplieron con los criterios de inclusión. El 50% (8/16) de los estudios revisados fueron realizados en países de Sur América, Centro América y del Caribe. El diseño de casos y controles fue el más frecuente. El anterior sistema de clasificación de casos (OMS-1997) fue utilizado en todos los estudios incluidos en esta revisión. Conclusiones: El estrés oxidativo-nitrosativo se encuentra presente en el curso de la infección por virus dengue, demostrado por los cambios en las concentraciones plasmáticas de óxido nítrico, antioxidantes y marcadores de lipoperoxidación y de oxidación de proteínas. Por último, parece existir una asociación entre la elevación de los niveles plasmáticos de los carbonilos proteicos y malondialdehído con la severidad del dengue.

Manifestaciones del dengue a nivel renal / Manifestations of dengue in the kidney

IIntroducción: el dengue es una infección con afectación multisistémica, autolimitada, con espectro clínico que varía de formas asintomáticas a graves y fatales. Hay descripciones de casos de afectación renal en todo el mundo. Objetivo: describir las manifestaciones renales por el dengue. Metodología: estudio observacional, descriptivo, prospectivo realizado en pacientes adultos con dengue grave internados en el Dpto. de Medicina Interna del Hospital Nacional (Itauguá, Paraguay) durante la epidemia del verano 2013-2013. Fueron evaluados parámetros clínicos y laboratoriales con énfasis en la función renal. Resultados: se reclutaron 135 pacientes, 69 varones y 66 mujeres, con edad media 42,7±18 años. En 37% de los casos había alguna comorbilidad. Se midió proteinuria de 24 hs en 34 sujetos, encontrándose en rango nefrótico en 8,8% y en rango elevado ( = 160 mg/día) en 67,6%. Otros hallazgos llamativos fueron la hematuria (38%) e hipertensión arterial transitoria (39%). Un solo paciente presentó alteración de urea y creatinina al alta. Conclusiones: las manifestaciones renales por el dengue grave son frecuentes, predominando la proteinuria, hematuria e hipertensión arterial, aunque son transitorias en la mayoría.

I Introduction: dengue fever is an infection with multisystem involvement, self-limiting, clinical spectrum ranging from asymptomatic to severe and fatal forms. There are descriptions of cases of renal disease worldwide. Objective: to describe renal manifestations of dengue. Methodology: observational, descriptive, prospective study in adult patients with severe dengue admitted to the Department of Internal Medicine, National Hospital (Itauguá, Paraguay) during summer 2013 to 2013 epidemic. We evaluated clinical and laboratory parameters with emphasis on renal function. Results: 135 patients, 69 men and 66 women were recruited, mean age 42.7 ± 18 years. In 37% of cases there was any comorbidity. 24 h proteinuria were measured in 34 subjects, being in nephrotic range at 8.8% and high range (= 160 mg / day) in 67.6%. Other striking findings were hematuria (38%) and transient hypertension (39%). Only one patient presented alterations in urea and creatinine at discharge. Conclusions: renal manifestations of severe dengue are common, predominantly proteinuria, hematuria and hypertension, although they are transient in most.

Proporción de leptospirosis y factores relacionados en pacientes con diagnóstico presuntivo de dengue, 2010-2012 / Leptospirosis percentage and related factors in patients having a presumptive diagnosis of dengue, 2010 -2012

Objetivo Identificar la presencia de leptospirosis y las variables sociodemográficas relacionadas, en pacientes con diagnóstico confirmado y descartado de dengue en el periodo 2010-2012, por medio de la técnica de microaglutinación (MAT). Materiales y Métodos Se realizó un estudio descriptivo retrospectivo de 238 sueros: 106 de pacientes fallecidos: 64 dengue negativo y 42 dengue positivo y 132 muestras de pacientes vivos dengue positivo: 29 confirmados por PCR y/o aislamiento viral y 103 con IgM positiva, a todos los sueros se les realizó la técnica de MAT para Leptospira, se revisaron las fichas epidemiológicas y se analizaron los datos. Resultados De los 42 pacientes fallecidos dengue positivo, 3 (7%) se encontraron positivos para Leptospira interrogans serogrupo Australis y Autumnalis; 2 mujeres, de 5 y 17 años y un hombre de 14 años.De los 64 pacientes fallecidos negativos para dengue, 7(11%) se encontraron positivos para L. interrogans de los serogrupos Pomona, Autumnalis, Canicola y Ballum; 5 hombres; edades entre 8 y 58 años; y 2 mujeres edades de 35 y 56 años. De los 103 pacientes vivos con IgM positiva para dengue, 3(2,9%) se encontraron positivos para Leptospira de los serogrupos Icterohaemorrhagiae, Cynopteri, Javanica, Proechimys y Autumnalis; 1 hombre y 2 mujeres. En los 29 pacientes vivos confirmados para dengue, no se encontraron positivos para Leptospira. Conclusiones Se debe sospechar de leptospirosis, no solo como único agente causal del síndrome febril, sino también de la coinfección que podría comprometer al paciente y estar relacionada con la mortalidad.(AU)

Objective Using the microscopic agglutination test (MAT) from 2010-2012 for identify ingleptospirosis-related and sociodemographic variables in patients havinga confirmed diagnosis of dengue and those for whom it had been discarded. Materials and Methods This was aretrospective study of 238 sera samples. 106 patients died, 64 of their samples were negative for dengue and 42 proved positive. 132 samples from live patients proved positive for dengue; 29 were confirmed by PCR and/orvirus isolation and 103 had positive IgM readings. MAT was used for all seraand diagnosing Leptospira, epidemiological records were reviewed and the data was analysed. Results 42 dengue positive patients died; 3 (7%) were positive for Leptospira interrogans sero group Australisautumnalis (two girls aged 5 and 17 years-old anda 14 year-old boy). Of the 64 deceased patients who proved negative for dengue, 7 (11%) were found positive for L.interrogans from sero groups Pomona, Autumnalis, Canicola and Ballum (5 malesaged 8to 58 years-old and 2 womenaged 35 and 56 years-old). Of the 103 living patients who proved positive for dengue IgM, 3 (2.9%) were positive for Leptospira icterohaemorrhagiae from the Cynopteri, Javanica Proechimys and Autumnalissero groups(1 maleand 2 females). None of the 29 living patients confirmedas having dengue were positive for Leptospira. Conclusions Leptospirosis should be suspected not onlyas the solecausative agent of febrile syndromebut also of co-infection which could compromisea patient and be related tomortality.(AU)

Dengue grave / Severe dengue

A dengue é uma doença febril infecciosa, caracterizada como um problema de saúde pública. É transmitida através da picada do mosquito Aedes aegypti, e a infecção pode ser causada por quatro sorotipos diferentes (DENV-1 a DENV-4). Dentre suas formas clínicas, a mais preocupante atualmente é a dengue grave, responsável pelo maior número de óbitos. Uma abordagem sistematizada, descartando os principais diagnósticos diferenciais e iniciando uma terapia adequada e precoce, é fundamental para evitar uma evolução desfavorável do quadro e suas possíveis complicações

Dengue fever is an infectious disease characterized as a public health problem. It is transmitted through the bite of the mosquito Aedes aegypti, and the infection can be caused by four distinct serotypes (DENV-1 to DENV-4). Among its clinical forms, the most worrying is currently severe dengue, the largest number of deaths. A systematic approach, dismissing the differential diagnosis and appropriate therapy and starting early, is essential to avoid an unfavorable evolution of the condition and its complications

Utilização de sinais de alarme para Dengue Grave em crianças por profissionais do Sistema Único de Saúde / Use of warning signs for severe dengue in children by professionals of the National Health System

Introdução: Dengue possui amplo espectro clínico, sendo o reconhecimento precoce de casos graves seguido de intervenção a principal estratégia para diminuição da letalidade. A identificação de sinais de alarme, que indicam risco de evolução para gravidade, é enfatizada na nova classificação das formas clínicas da Organização Mundial de Saúde (OMS) e na de manejo clínico adotada pelo Ministério da Saúde do Brasil (MS). [...] Objetivo: Identificar os sinais de alarme para dengue grave em crianças, reconhecidos por profissionais e técnicos do Sistema Único de Saúde, por meio da versão brasileira de instrumento proposto pela OMS. Métodos: Tradução e retrotradução do questionário original em inglês, seguida de discussão com especialistas e pré-teste do instrumento. Inquérito realizado em 2011 por meio da aplicação da versão brasileira do questionário a médicos (M), enfermeiros (E) e técnicos de enfermagem (T) de duas unidades de atenção primária, uma secundária e duas terciárias, todas do Sistema Único de Saúde (n=488). Foram coletadas informações sociodemográficas, experiência no atendimento de dengue e sobre o uso e classificação de importância dos sinais de alarme para dengue grave definidos pela OMS e MS. Diferenças nas distribuições de frequência das variáveis por nível de atenção e ocupação foram avaliadas pelo teste qui-quadrado e Kruskal-Wallis (p<0,05). Resultados: Quanto à versão brasileira do questionário OMS, apenas a questão relativa à classificação dos sinais foi reformulada por sua difícil compreensão. Do total, 474 (97 por cento) participantes responderam ao questionário, 40 por cento M, 23 por cento E e 37 por cento T; 75 por cento de unidades de atenção terciária...

Introduction: Dengue is a disease with a broad clinical spectrum. The early recognition andtreatment of severe cases is the main strategy to reduce lethality. The revised dengue caseclassification proposed by the World Health Organization (WHO), as well as the clinicalmanagement guideline adopted by the Brazilian Ministry of Health (MS), emphasizes theearly identification of warning signs as predictors of severe outcomes.[...] Objective: Toidentify dengue warning signs in children recognized by the health personnel of the NationalHealth System (SUS) using the Brazilian version of an instrument proposed by the WHO.Methods: Translation and back translation of the WHO instrument followed by an expertpanel consensus and a pretest of the first prototype of the Brazilian version. The survey wasconducted in 2011 by applying the final Brazilian version of the WHO questionnaire tophysicians (MD), nurses (N) and nurse assistants (NA) of two primary care units, onesecondary and two tertiary health care facilities of SUS (n=488). Data collection includedsocio-demographic characteristics, dengue clinical experience, use and ranking of the denguewarning signs defined by WHO and MS. The chi-square and Kruskal-Wallis tests (p<0.05)were used to assess whether there are differences in the use of warning signs according to thelevel of health care and occupations...

Dengue / Dengue

El dengue es una enfermedad infecciosa, la cual sin tratamiento médico, en algunos casos, puede llevar a la muerte.1 Se transmite mediante la picadura de la hembra del mosquito infectado Aedes aegypti, principal vector, que se cría en el agua acumulada en recipientes y objetos en desuso, actualmente extendido por gran parte de las regiones de clima tropical y ecuatorial del mundo. También mediante otro vector, el Aedes albopictus, cuya máxima actividad se desarrolla durante el día...

Incidencia de infecciones sintomáticas y asintomáticas por virus dengue en Maracay, Venezuela: 2006-2007 / Incidence of symptomatic and asymptomatic dengue virus infections in Maracay, Venezuela: 2006-2007

Con el objetivo de estimar las tasas de incidencia de infecciones sintomáticas y asintomáticas por virus dengue (DENV) durante un año (octubre 2006-septiembre 2007) en cuatro barrios de Maracay (Venezuela) se realizó un estudio prospectivo consistente de visitas domiciliarias, tres veces por semana, para detectar casos de dengue y de encuestas serológicas semestrales para determinar infecciones asintomáticas probables por DENV. Los sujetos de estudio pertenecían a una cohorte de 2663 personas ≥5 años de edad. El diagnóstico confirmatorio de DENV se realizó mediante la reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR). Las pruebas serológicas se realizaron mediante el ensayo inmunoenzimático de captura de IgM anti-dengue (MAC-ELISA). Los resultados determinaron tasas de incidencia de 5,7 y 18,6 por 100 000 personas/día (p/d) para las infecciones sintomáticas y asintomáticas, respectivamente. La tasa de incidencia de las infecciones sintomáticas observada en las personas <15 años de edad fue significativamente mayor que la encontrada en los sujetos ≥15 años (15,8 versus 2,9 por 100 000 p/d). Por otro lado, las tasas de incidencia de las infecciones asintomáticas en ambos grupos de edad fueron similares (17,3 y 18,9 por 100 000 p/d, respectivamente). Se detectaron los cuatro serotipos del DENV en tres de los barrios estudiados. Se observó que la edad y la hiperendemicidad fueron probablemente los factores que más contribuyeron a la incidencia del dengue en los cuatro barrios investigados. Seguramente, las infecciones asintomáticas contribuyeron a incrementar la transmisión viral en el área de estudio.

The incidence rates of symptomatic and asymptomatic dengue virus (DENV) infections in four "barrios" of Maracay, Venezuela, during one-year (October 2006-September 2007) were estimated. A prospective study consisting of house visits three-times a week to detect dengue cases, and semiannual serological surveys to determine probable asymptomatic dengue virus (DENV) infections was conducted. The study subjects belonged to a cohort of 2,663 people ≥5 year-old. Confirmatory diagnosis of DENV infections was carried out by reverse-transcriptase polymerase chain reaction (RT-PCR). Serological surveys were performed by anti-dengue IgM-capture immunoassay (MAC-ELISA). The results showed that the incidence rates for symptomatic and asymptomatic infections were determined to be 5.7 and 18.6 per 100,000 persons/day (p/d), respectively. The incidence rate of symptomatic infections was significantly higher in persons <15 year-old than that found in subjects ≥15 years (15.8 versus 2.9 per 100,000 p/d). On the other hand, the incidence rates of asymptomatic infections in both age groups were similar (17.3 and 18.9 per 100,000 p/d, respectively). All four DENV serotypes were detected in three of the four "barrios" studied. Finally, age and hyperendemicity were probably the contributing factors to the incidence of dengue in the four "barrios" investigated. Surely, the asymptomatic infections contributed to increase the viral transmission in the study area.

Dengue infection in patients presenting with neurological manifestations in a dengue endemic population / Infección de dengue en pacientes que se presentan con manifestaciones neurológicas en una población con dengue endémico

The evaluation of the contribution of neurological dengue in suspected central nervous system (CNS) viral infections is essential to better understand the impact of neurological dengue on morbidity and mortality in dengue endemic regions such as Jamaica. For this study, 401 cases of suspected viral CNS infections were investigated for evidence of dengue infection. The frequency of neurological dengue among these CNS cases was found to be 13.5% (54/401). Fifty-three cases were confirmed serologically by haemagglutination inhibition assay (HI) and IgM antibody (ELISA) and the virus was isolated in one case only. Clinical manifestations among dengue positive CNS cases included encephalitis in 51.8% (28/54), meningitis in 33.3% (18/54), seizures in 11.1% (6/54) and acute flaccid paralysis/Guillain-Barré syndrome in 3.7% (2/54). The clinical diagnosis of dengue neurological infection corresponded with laboratory confirmation in 22.2% (12/54) of cases only. Deaths occurred in 3.7% (2/54) of cases and were associated with patients with dengue neurological infection. The high risk of dengue among patients with suspected viral CNS infections in this study supports the need for an increased index of suspicion of dengue in patients presenting with neurological manifestations in dengue endemic countries.

La evaluación de la contribución del dengue neurológico en las infecciones virales sospechadas del sistema nervioso central (SNC) resulta esencial para un mejor entendimiento del impacto del dengue neurológico en la morbilidad y mortalidad en regiones donde el dengue es endémico tales como Jamaica. Para este estudio 401 casos de infecciones virales sospechadas del SNC fueron investigados en busca de evidencia de infección por dengue. Se haló entonces que la frecuencia del dengue neurológico entre estos casos de SNC, fue de 13.5% (54/401). Cincuenta y tres casos fueron confirmados por serología mediante ensayos de inhibición de hemaglutinación (IH) y ELISA para la detección de anticuerpos IgM, siendo el virus aislado sólo en un caso. Las manifestaciones clínicas entre los casos que resultaron positivos al dengue, incluyeron encefalitis en 51.8 % (28/54), meningitis en 33.3% (18/54), convulsiones en 11.1% (6/54) y parálisis facial aguda/síndrome Barré Guillain en 3.7% (2/54). El diagnóstico clínico de infección neurológica por dengue estuvo en correspondencia con la confirmación del laboratorio sólo en el 22.2% (12/ 54) de los casos. Se produjeron muertes en el 3.7% (2/54) de los casos, las cuales estuvieron asociadas con pacientes con infección neurológica por dengue. El alto riesgo de dengue entre los pacientes con sospecha de infecciones virales de SNC en este estudio, apunta a la necesidad de aumentar el índice de sospecha de dengue en pacientes que se presentan con manifestaciones neurológicas en países donde el dengue es endémico.

The impact of dengue on liver function as evaluated by aminotransferase levels

The objective of this study was to evaluate the impact of dengue virus infection on liver function by measuring aminotransferase in blood samples from patients serologically diagnosed by according to two MAC-ELISA protocols. Degrees of liver damage were classified according to aminotransferase levels: grade A - normal enzyme levels; grade B - increased levels of at least one of the enzymes; grade C - increased, with at least one of the enzymes being at levels higher than three times the upper reference values; grade D - acute hepatitis, with aminotransferase levels at least ten times their normal values. Of the 169 serologically confirmed cases of dengue at the dengue referral center in Campos dos Goytacazes in the state of Rio de Janeiro, Brazil, 65.1 percent had abnormal aminotransferase levels: 81 cases being classified as grade B, 25 as grade C and 3 as grade D. A further 34.9 percent of cases had normal enzyme levels and were classified as grade A. Liver damage is a common complication of dengue infection and aminotransferase levels are a valuable marker for monitoring these cases.

Clinicopathologic manifestations and outcome of dengue fever and dengue haemorrhagic fever.

During the peak period of outbreak from July through October, during the year 2000 through 2002, a total of 390 cases of either dengue fever (DF) or dengue haemorrhagic fever (DHF) were collected from medicine outpatient department (MOPD) of Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka to study their clinicopathologic manifestations and management outcome. Data were collected using a structured questionnaire. Almost all of the patients presented with fever (100%), headache (98.2%), bodyache (97.7%), anorexia (100%) and nausea (100%) and the vast majority had skin rash (78.5%), backache (78.2%) and retro-orbital pain (79.7%). Mean +/-SD of duration of total illness was 7.57 +/- 1.11 days and that of fever and skin rash were 5.40 +/- 0.86 and 3.02 +/- 0.78 days respectively. Mean +/-SD of platelet count was 69643.59 +/- 32043.97/mm3 of blood and that of haematocrit was 41.18 +/- 2.65%. Almost all of the patients (97.7%) developed thrombocytopenia but only 4.1% developed leucopenia at sometime during the course of the disease and anaemia was found in 49.4% of the patients. Both anti-dengue IgG and anti-dengue IgM were positive in 55.1% of patients and either anti-dengue IgG or anti-dengue IgM was positive in 23.6% and 21.3% of patients respectively. Management outcome of the patients was quite satisfactory without any case fatality.

Patogenia das infecçöes pelos vírus do dengue / Pathogenesis of dengue virus infections

Neste trabalho de revisäo, analisam-se aspectos das infecçöes primárias e secundárias pelos vírus do dengue, ressaltando a resposta imune benéfica, que impede a reinfecçäo e a resposta imune que facilita a entrada dos vírus do dengue em macrófagos e que é parte importante no mecanismo fisiopatológico do dengue hemorrágico. Esta forma de dengue é conseqüência de uma anômala resposta imune, envolvendo leucócitos, citocinas e imunocomplexos, causando aumento da permeabilidade por má funçäo vascular endotelial, sem destruiçäo do endotélio, com extravasamento de líquidos para o interstício, causando queda da pressäo arterial e manifestaçöes hemorrágicas, associadas a trombocitopenia.

Vacinas contra o dengue / Dengue vaccines

O controle do dengue é feito, nos dias atuais, em todo o mundo, seguindo normas de combate aos mosquitos vetores preconizadas por sanitaristas do começo do século. O controle e a erradicaçäo do Aedes aegypti, vetor do dengue, é bastante difícil e necessita de grandes investimentos com funcionários, máquinas, venenos e campanhas educacionais permanentes. A alternativa ideal para o controle do dengue seria através do uso de vacinas. Neste trabalho de revisäo, analisam-se pesquisas para o desenvolvimento de vacinas contra dengue, incluindo: as do vírus vivo atenuado; as de engenharia genética (vacinas recombinantes) tendo abordagens relativas à expressäo de proteínas de dengue em células eucarióticas, aos vírus recombinantes, aos vírus mutantes ou quiméricos, e às vacinas com vetores vivos. Ainda, abordam-se as vacinas de DNA. Observa-se que as vacinas de vírus vivo e atenuado säo aquelas que têm as melhores perspectivas para serem utilizadas de forma generalizada, no controle do dengue, dentro de alguns anos.