Guía basada en la evidencia. Diagnóstico y manejo del síndrome de Guillain-Barré en diez pasos / Evidence based guidelines. Diagnosis and management of Guillain-Barré syndrome in ten steps

Resumen El síndrome de Guillain-Barré (SGB) es una enfermedad inmunológica del nervio periférico y las raíces nerviosas, poco frecuente, potencialmente mortal y que suele desencadenarse por infecciones. La incidencia del SGB puede aumentar durante el brote de enfermedades infecciosas, tal como se observó en las epidemias del virus Zika en la Polinesia Francesa en 2013 y en América Latina en 2015. El diagnóstico y el manejo clínico del SGB pueden ser complicados ya que su presentación y el curso de la enfermedad son heterogéneos, y actualmente no se cuenta con guías clínicas internacionales. Para respaldar a los médicos, especialmente en el contexto de un brote de una enfermedad infecciosa, hemos desarrollado una guía clínica aplicable en todo el mundo para el diagnóstico y el tratamiento del SGB. La guía se basa en literatura actualizada y el consenso de expertos, y tiene una estructura de diez pasos para facilitar su uso en la práctica clínica. Inicialmente, brindamos una introducción a los criterios de diagnóstico, variantes clínicas y diagnósticos diferenciales del SGB. Los diez pasos luego abordan el reconocimiento y el diagnóstico temprano del SGB, la admisión a la unidad de cuidados intensivos, indicación y selección de tratamiento, seguimiento y tratamiento de la progresión de la enfermedad, predicción del curso clínico, resultados y tratamiento de complicaciones y secuelas.

Abstract Guillain-Barré syndrome (GBS) is a rare, but potentially fatal, immune-mediated disease of the peripheral nerves and nerve roots that is usually triggered by infections. The incidence of GBS can therefore increase during outbreaks of infectious diseases, as was seen during the Zika virus epidemics in 2013 in French Polynesia and in 2015 in Latin America. Diagnosis and management of GBS can be complicated as its clinical presentation and disease course are heterogeneous, and no international clinical guidelines are currently available. To support clinicians, especially in the context of an outbreak, we have developed a globally applicable guideline for the diagnosis and management of GBS. The guideline is based on current literature and expert consensus, and has a ten-step structure to facilitate its use in clinical practice. We first provide an introduction to the diag nostic criteria, clinical variants and differential diagnoses of GBS. The ten steps then cover early recognition and diagnosis of GBS, admission to the intensive care unit, treatment indication and selection, monitoring and treatment of disease progression, prediction of clinical course and outcome, and management of complications and sequelae.

Prevalence and diagnostic accuracy of microcephaly in a pediatric cohort in Brazil: a retrospective cross-sectional study

Abstract Objective We sought to describe the prevalence of microcephaly and to compare the different cutoff points established by the Brazilian Ministry of Health at various times during a Zika virus epidemic. As a secondary aim, we investigated the possible etiology of the microcephaly. Method This retrospective study utilized newborn participants in the Zika Cohort Study Jundiaí. Newborns from the Zika Cohort Study Jundiaí with an accurate gestational age determination and complete anthropometric data were analyzed, and microcephaly was diagnosed according to the INTERGROWTH-21st curve. At delivery, fluids were tested for specific antibodies and for viruses. Brain images were evaluated for microcephaly. Receiver Operating Characteristic curves were plotted to define the accuracy of different cutoff points for microcephaly diagnosis. Results Of 462 eligible newborns, 19 (4.1%) were positive for microcephaly. Cutoff points corresponding to the curves of the World Health Organization yielded the best sensitivity and specificity. Three of the microcephaly cases (15.8%) were positive for Zika virus infections; nine (47.4%) had intrauterine growth restriction; one had intrauterine growth restriction and was exposed to Zika virus; three had a genetic syndrome (15.8%); and three had causes that had not been determined (15.8%). Conclusions Microcephaly prevalence was 4.1% in this study. Cutoff values determined by the World Health Organization had the highest sensitivity and specificity in relation to the standard IG curve. The main reason for microcephaly was intrauterine growth restriction. All possible causes of microcephaly must be investigated to allow the best development of an affected baby.

Use of Cerebrospinal Fluid for the Diagnosis of Neuroinvasive Dengue, Zika, and Chikungunya: A 19-year systematic review

Abstract INTRODUCTION: Cerebrospinal fluid analysis contributes to the diagnosis and neuropathogenesis of neuroinvasive arboviruses. Neurological complications caused by dengue, Zika, and chikungunya infections have high clinical relevance because of their high potential to cause death or neurological deficits. We aimed to evaluate the use of cerebrospinal fluid assays for diagnostic support in neurological disorders associated with dengue, chikungunya, and Zika infections. METHODS: A systematic review was carried out by searching the electronic databases LILACS, PubMed, Scopus, and Embase for articles written in English, Portuguese, or Spanish in the last 19 years. Published studies were reviewed using the terms "dengue," "Zika", "chikungunya", alone or in combination with "cerebrospinal fluid" in the period from 2000 to 2019. RESULTS: A total of 98,060 studies were identified; of these, 1.1% (1,041 studies, 58,478 cases) used cerebrospinal fluid assays for neurological investigations. The most frequent neurological disorders included encephalitis (41.4%), congenital syndromes (17%), and microcephaly associated with Zika virus infections (8.9%). Neuroinvasive disorders were confirmed in 8.03% of 58,478 cases by specific cerebrospinal fluid analyses. The main methods used were IgM-specific antibodies (66%) and reverse transcription-polymerase chain reaction (10%). The largest number of scientific papers (29%) originated from Brazil, followed by India (18.4%) and the United States (14.4%). CONCLUSIONS: Although cerebrospinal fluid analysis is of great importance for increasing neurological diagnostic accuracy and contributes to the early diagnosis of neuroinvasive dengue, chikungunya, and Zika infections, it is underused in routine laboratory investigations worldwide.

Avaliação da implantação da resposta à emergência de saúde pública de microcefalia no Estado de Pernambuco, Brasil / Evaluation of implementation of the response to the public health emergency of microcephaly in Pernambuco State, Brazil / Evaluación de la implantación de la respuesta a la emergencia de salud pública por microcefalia en el Estado de Pernambuco, Brasil

Resumo: Este estudo teve por objetivo avaliar o grau de implantação da resposta à emergência da microcefalia associada ao vírus Zika em Pernambuco, Brasil. Trata-se de um estudo avaliativo normativo realizado no epicentro inicial da emergência em saúde pública internacional, ocorrida entre outubro de 2015 e julho de 2017. Elaborou-se um modelo lógico da intervenção sob análise, contendo os componentes Gestão, Vigilância e Assistência em suas dimensões de estrutura, processo e resultado, a partir de publicações técnicas e normativas institucionais, além de uma matriz de indicadores correspondente para julgamento. Coletaram-se dados a partir da aplicação de questionário, observação direta e consulta a documentos oficiais. Os resultados mostraram implantação parcial (74,9%) da resposta à emergência de microcefalia pela Secretaria Estadual de Saúde, com a dimensão processo atingindo 75% do esperado, e a estrutura, 74,5%. A Vigilância foi o único componente avaliado como implantado (81%), ainda que com carência de investimentos regionais e laboratorial, e a Gestão (74,2%) e a Assistência (68,8%), parcialmente implantadas, com insuficiências nos quesitos referentes a recursos humanos e estrutura física, planejamento e avaliação. Conclui-se que o grau de implantação da resposta à emergência em saúde pública internacional de microcefalia associada ao vírus Zika foi avaliado como implantação parcial, com diferentes níveis entre os componentes da intervenção, sobressaindo-se a Vigilância em comparação à Gestão e Assistência. As inconformidades sinalizam a necessidade de investimentos para o enfrentamento de futuras emergências em saúde pública, com vistas a intervenções mais oportunas e adequadas.

Abstract: This study aimed to assess the degree of implementation of the response to the emergency of microcephaly associated with Zika virus in Pernambuco State, Brazil. This was a normative evaluative study conducted in the initial epicenter of the public health emergency of international concern, from October 2015 to July 2017. A logical model was produced for the intervention under analysis, with the components of Management, Surveillance, and Care in the dimensions of structure, process, and result, based on technical publications and institutional guidelines, in addition to a corresponding log frame of indicators for assessment. Data were collected through a questionnaire, direct observation, and consultation of official documents. The results showed partial implementation (74.9%) of the response to the microcephaly emergency by the Pernambuco State Health Department, with the process dimension reaching 75% of the expected level and the structure dimension, 74.5%. Surveillance was the only component that was assessed as implemented (81%), although with a shortage of regional and laboratory investments, while Management (74.2%) and Care (68.8%) were partially implemented, with insufficiencies in items related to human resources and physical structure, planning, and evaluation. In conclusion, the response to the public health emergency of international concern involving microcephaly associated with the Zika virus was assessed as partially implemented, with different levels between the intervention´s components, especially surveillance when compared to management and care. The shortcomings signal the need for investments to deal with future public health emergencies, with a view towards more timely and adequate interventions.

Resumen: El objetivo de este estudio fue evaluar el grado de implantación de la respuesta a la emergencia de microcefalia, asociada al virus Zika, en Pernambuco, Brasil. Se trata de un estudio evaluativo normativo, realizado en el epicentro inicial de la emergencia en salud pública internacional, ocurrida entre octubre de 2015 y julio de 2017. Se elaboró un modelo lógico de la intervención, bajo el análisis que contenía los componentes Gestión, Vigilancia y Asistencia, en sus dimensiones de estructura, proceso y resultado, a partir de publicaciones técnicas y normativas institucionales, y una matriz de indicadores correspondiente para el juicio. Se recogieron datos a partir de la aplicación del cuestionario, observación directa y consulta de documentos oficiales. Los resultados mostraron una implantación parcial (74,9%) de la respuesta a la emergencia de microcefalia por la Secretaría Estatal de Salud, con la dimensión proceso alcanzando a un 75% de lo esperado y la estructura, un 74,5%. La Vigilancia fue el único componente evaluado como implantado (81%), aunque con carencia de inversiones regionales y de laboratorio, y la Gestión (74,2%) y Asistencia (68,8%), parcialmente implantadas, con insuficiencias en los requisitos referentes a recursos humanos y estructura física, planificación y evaluación. Se concluye que el grado de implantación de la respuesta a la emergencia en salud pública internacional de microcefalia, asociada al virus Zika, fue evaluado como implantación parcial, con diferentes niveles entre los componentes de la intervención, sobresaliendo la Vigilancia, en comparación con la Gestión y la Asistencia. Las inconformidades indican la necesidad de inversiones para enfrentar futuras emergencias en salud pública, con vista a intervenciones más oportunas y adecuadas.

Analytical and clinical performance of molecular assay used by the Brazilian public laboratory network to detect and discriminate Zika, Dengue and Chikungunya viruses in blood

ABSTRACT In response to the Zika epidemics in Brazil, the ZDC molecular assay (Bio-Manguinhos) was developed and registered at the Brazilian Regulatory Agency of Health Surveillance - ANVISA. The circulation of Zika (ZIKV) Dengue (DENV) and Chikungunya (CHIKV) viruses and their clinical similarities are challenges to correctly diagnose these viruses. The simultaneous detection of ZIKV, DENV and CHIKV is an important tool for diagnosis and surveillance. Here, we present the analytical and clinical performance evaluation of ZDC molecular assay (Bio-Manguinhos) at the public health laboratories three years after its registration at ANVISA. The clinical performance demonstrates the ZDC molecular assay (Bio-Manguinhos) has 100% sensitivity and 100% specificity to detect and discriminate ZIKV, CHIKV, and DENV from clinical plasma samples. The ZDC molecular assay (Bio-Manguinhos) results were highly reproducible and no cross-reactivity was seen during testing with a panel of other infectious agents. In conclusion, the ZDC molecular assay (Bio-Manguinhos) is an accurate and reliable tool to monitor Zika, dengue and chikungunya infections in countries like Brazil with simultaneous circulation of the three viruses.

Neurological growth and development of children asymptomatic at birth whose mothers had Zika during pregnancy

Abstract INTRODUCTION: Newborn who had Zika vírus but did not show microcephaly at birth may have neuropsychomotor development problems. We aimed to evaluate the developmental and anthropometric milestones of asymptomatic children whose mothers had Zika during pregnancy in Northeastern Brazil in 2015 and 2016. METHODS: We conducted a descriptive cross-sectional case series study of children in Fortaleza born without microcephaly whose mothers had Zika during pregnancy. Home visits were undertaken to evaluate the developmental milestones and gather anthropometric data of the children and to conduct semi-structured interviews with the mothers to identify their socioeconomic and gestational profiles and assess the newborns after birth. RESULTS: In total, 30 cases were identified. Of these, 17 children and their mothers participated in the study. The median age of the mothers at the time of delivery was 26 years. All were symptomatic, and TORCH was negative. At the time of the home visit, all had growth profiles suitable for their age. However, nearly all children (15/17, 88.2%) presented at least one developmental delay, considering their age group. CONCLUSIONS: There were late changes in the neuropsychomotor development of children born to mothers who had Zika during pregnancy, suggesting the need for specialized medical follow-ups.

Updating zika diagnostic methods: the point-of-care approach

Abstract Zika virus (ZIKV) has gained great importance worldwide since the past epidemic that occurred in 2015 in Brazil. Early identification of ZIKV is critical to minimize transmission and prevents potentially devastating consequences, including microcephaly in neonates of infected women, congenital blindness, or Guillain-Barré Syndrome. However, this is not an easy task, considering that approximately 80% of ZIKV infection cases are asymptomatic or oligosymptomatic, there are diverse modes of transmission (vertical transmission is through vectors and horizontal transmission through blood, saliva, semen, and urine from infected people), and the fact that ZIKV has a high identity percentage with other cocirculating Flaviviruses such as dengue. Here, we review ZIKV diagnostic methods, with special emphasis on the development of point-of-care diagnostic assays, since these devices commonly have two important advantages: they provide prompt screening and are affordable.

Diabetes insípida y virus del Zika / Diabetes insipid us and Zika virus

La diabetes insípida es el resultado de una secreción o acción reducidas de la hormona vasopresina, expresada clínicamente por un cuadro de poliuria-polidipsia. Los arbovirus pueden tener afinidad por el sistema nervioso y se ha demostrado que el Zika desencadena un trastorno autoinmune que ataca a las células nerviosas, lo que puede traer como consecuencia una diabetes insípida central. En la literatura médica nacional e internacional revisada no se reportan casos anteriores donde se vincule la diabetes insípida con el virus del Zika. Se presenta un caso a propósito de esta asociación: paciente femenina de 53 años, diagnosticada con infección por el virus del Zika dos semanas antes de comenzar con los síntomas sugestivos de diabetes insípida. El potencial neurotrópico del virus, así como los resultados en la resonancia magnética nuclear y la determinación de marcadores de autoinmunidad anti-ADNdc positivos, son elementos que apoyan la hipótesis de que la paciente presentó una posible hipofisitis autoinmune, como respuesta inflamatoria post-infección, desarrollando diabetes insípida central transitoria(AU)

Diabetes insipidus is the result of reduced secretion or action of the vasopressin hormone, which is clinically expressed by a polyuria-polydipsia picture. Arboviruses can have a nervous system affinity and Zika has been shown to trigger an autoimmune disorder that attacks nerve cells, which can result in central diabetes insipidus. The reviewed national and international medical literatures does not report previous cases linking diabetes insipidus with Zika virus. It is presented a case about this association: 53-year-old female patient diagnosed with Zika virus infection two weeks before starting symptoms suggestive of diabetes insipidus. The neurotropic potential of the virus, as well as the results in nuclear MRI and the determination of positive anti-ADNdc autoimmunity markers are elements that support the hypothesis that the patient had a possible autoimmune hypophysis, as a post-infection inflammatory response, developing transient central diabetes insipidus(AU)

Clinical and laboratory findings of acute Zika virus infection in patients from Salvador during the first Brazilian epidemic

Abstract Several major epidemics of Zika fever, caused by the ZIKA virus (ZIKV), have emerged in Brazil since early 2015, eventually spreading to other countries on the South American continent. The present study describes the clinical manifestations and laboratory findings of patients with confirmed acute ZIKV infection during the first epidemic that occurred in Salvador, Brazil. All included patients were seen at the emergency room of a private tertiary hospital located in Salvador, Brazil from 2015 through 2017. Patients were considered eligible if signs of systemic viral febrile disease were present. All individuals were tested for ZIKV and Chikungunya infection using PCR, while rapid test was used to detect Dengue virus antibodies or, alternatively, the NS1 antigen. A diagnosis of acute ZIKV infection was confirmed in 78/434 (18%) individuals with systemic viral febrile illness. Positivity was mainly observed in blood, followed by saliva and urine. Coinfection with Chikungunya and/or Dengue virus was detected in 5% of the ZIKV-infected patients. The most frequent clinical findings were myalgia, arthralgia and low-grade fever. Laboratory analysis demonstrated normal levels of hematocrit, platelets and liver enzymes. In summary, in acute settings where molecular testing remains unavailable, clinicians face difficulties to confirm the diagnosis of ZIKV infection, as they rely only on clinical examinations and conventional laboratory tests.

Enfrentando uma nova realidade a partir da síndrome congênita do vírus zika: a perspectiva das famílias / Facing a new reality from the Zika Virus Congenital Syndrome: the families perspective

Resumo Este artigo apresenta os resultados parciais da pesquisa sobre o enfrentamento às implicações sociais da síndrome congênita do vírus zika (SCVZ). Buscou-se analisar as repercussões trazidas pelo diagnóstico na vida das famílias atendidas num Instituto de referência no Rio de Janeiro, a partir de um estudo qualitativo, conduzido pela análise temática de conteúdo das entrevistas semiestruturadas realizadas junto a 15 mães, no período de outubro de 2017 a junho de 2018. Os resultados revelaram o desamparo de famílias e profissionais de saúde frente à revelação de um diagnóstico difícil e inédito; a ausência de estruturação de uma rede de referência e contrarreferência no atendimento às crianças quando recém-diagnosticadas; a imposição de uma rotina exaustiva de cuidados, gerando isolamento social, exaustão e sobrecarga dessas mulheres; e a dificuldade de acesso às políticas públicas. Entre os recursos de enfrentamento a essas adversidades destacaram-se a religiosidade e a articulação com outras mulheres que atravessavam a mesma experiência.

Abstract This paper presents the partial results of the research on the social implications of addressing the Zika Virus Congenital Syndrome (ZVCS). This study aimed to analyze the repercussions of the diagnosis on the life of the families attended at an Institute of reference in Rio de Janeiro, based on a qualitative study built on the thematic analysis of the data collected through semi-structured interviews with 15 mothers from October 2017 to June 2018. The results revealed the helplessness of families and health professionals faced with the revelation of an unprecedented and challenging diagnosis, the lack of a structured referral and counter-referral network in the care of children when newly diagnosed, the imposition of an exhaustive care routine, generating social isolation, exhaustion and overload of these women, and the difficult access to public policies. Among the primary resources to cope with these adversities were the religiosity and articulation with other women who experienced the same situation.

Imagem corporal em adolescentes: associação com estado nutricional e atividade física / Body image among adolescents: the association between nutritional status and physical activity

Resumo O objetivo deste artigo é verificar a associação do estado nutricional e da atividade física com a percepção de satisfação da imagem corporal em uma amostra de adolescentes de Curitiba/PR. Compuseram a amostra 844 adolescentes entre 11 a 17 anos. O nível de atividade física foi avaliado pelo Questionário de Atividade Física para Adolescentes. A percepção da imagem corporal foi avaliada pela Escala de Figura de Silhueta e pelo Body Shape Questionnarie. A associação do estado nutricional e do nível de atividade física com a satisfação com a imagem corporal foi realizada através da regressão logística multinominal para obtenção da razão de chances com intervalo de confiança de 95% e p<0,05. O sobrepeso/obesidade esteve associado positivamente com a insatisfação com a imagem corporal (IIC) moderada e grave para meninas (RC: 6,20; IC95%: 2,62 - 14,66 e RC: 6,20; IC95%: 4,10 - 9,36) e meninos (RC: 1,95; IC95%: 1,06 - 3,59 e RC: 3,91; IC95%: 2,57 - 5,95) e com o desejo de diminuir a silhueta para meninos e meninas (RC: 4,86; IC95%: 3,37 - 7,00 e RC: 6,46, IC95%: 4,12 - 10,14). O nível de atividade física não se mostrou associado com a IIC. Adolescentes com sobrepeso e obesidade apresentam maior chance de reportarem IIC. A atividade física não esteve relacionada com a IIC.

Abstract The aim of this article is to verify the association between nutritional status and physical activity with the perception of body image satisfaction in a sample of adolescents from Curitiba, State of Paraná. The sample consisted of 844 adolescents of 11 to 17 years of age. The level of physical activity was evaluated by the Physical Activity Questionnaire for Adolescents. Body image perception was assessed by the Silhouette Shape Scale and the Body Shape Questionnaire. The association between nutritional status and level of physical activity with satisfaction with body image was performed through multinomial logistic regression to obtain the odds ratio with a 95% confidence interval and p < 0.05. Overweight/obesity was positively associated with moderate and severe body image dissatisfaction (BID) among girls (OR: 6.20; 95%CI: 2.62 - 14.66 and OR: 6.20; 95%CI: 4.10 - 9.36) and boys (OR: 1.95; 95%CI: 1.06 - 3.59 e OR: 3.91; 95%CI: 2.57 - 5.95) and with the desire to decrease the silhouette for boys and girls (OR: 4.86; 95%CI: 3.37 - 7.00 and OR: 6.46; 95%CI: 4.12 - 10.14). The level of physical activity was not associated with BID. Adolescents who are overweight and obese are more likely to admit to BID. Physical activity was not related to BID.

Prevalencia de embarazos con infección por virus Zika en una Unidad de Primer Nivel de Atención en Coatzacoalcos Veracruz México del Instituto Mexicano del Seguro Social / PREVALENCE OF PREGNANCIES WITH ZIKA VIRUS INFECTION IN A FIRST LEVEL CARE UNIT IN COATZACOALCOS VERACRUZ MEXICO OF THE MEXICAN INSTITUTE OF SOCIAL SECURITY

El virus Zika, es un arbovirus del género flavivirus (familia Flaviviridae), muy cercano filogenéticamente al del dengue, fiebre amarilla, la encefalitis japonesa, o el virus del Nilo Occidental. El presente estudio exploratorio busca identificar los casos confirmados y sugestivos de infección por virus Zika en mujeres embarazadas en la Unidad de Medicina Familiar N° 60 del IMSS de Coatzacoalcos, Veracruz. México como primera aproximación epidemiológica en esta región.

The Zika virus is an arbovirus of the genus flavivirus (family Flaviviridae), very closely phylogenetically a virus such as dengue fever, yellow fever, Japanese encephalitis, or West Nile virus. According to the Epidemiological Surveillance System for Zíka Virus Disease, until November 4th, 2016, in Mexico there were 6,094 confirmed cases of infection and 3,167 suspected cases of Zika virus infection in pregnant women in 24 states of the Mexican Republic, with a higher prevalence in Veracruz, Chiapas, Colima, Campeche, Yucatan and Quintana Roo. This is an original study that focuses on identifying the confirmed and suggestive cases of Zika virus infection in pregnant women in the Family Medicine Unit No. 60 of the IMSS in Coatzacoalcos, Veracruz. Mexico; It is an exploratory study in the registry of cases of pregnant women with Zika virus infection in the Family Medicine Unit No. 60 of Coatzacoalcos, Veracruz, Mexico as epidemiological basis

Caracterización clínica epidemiológica de pacientes pediátricos con zika en epidemia / Clinical-epidemiological characterization of pediatric patients with zika in epidemic

Introducción: El zika es considerado una virosis emergente, nunca antes presente en Cuba. Objetivo: Caracterizar desde el punto de vista clínico epidemiológico a pacientes pediátricos con zika confirmado. Métodos: Estudio descriptivo transversal realizado en el Hospital Pediátrico Leonor Pérez entre 2016- 2017, en el transcurso de la epidemia. Se analizaron 140 historias clínicas de pacientes con zika confirmado por reacción en cadena de la polimerasa en suero y orina. Se midieron variables clínicas, de laboratorio y se calculó la tasa asistida. Resultados: La tasa asistida fue 44,35 × 100 casos sospechosos. De las historias clínicas analizadas, 72,1 por ciento correspondió al sexo masculino y el grupo de edad de 10 a 15 años. La reacción en cadena de la polimerasa fue positiva en mayor porcentaje en orina que en suero: 52,1 y 40,7 por ciento respectivamente y en correspondencia con el día de toma de la muestra de orina. El exantema estuvo presente en 84,3 por ciento de pacientes y la fiebre en 70 por ciento. El prurito, ojos rojos, cefalea, malestar general, dolor retroocular, odinofagia, artralgia, anorexia y edemas, se observó en menos de 35 por ciento de los casos. Los promedios de los componentes del hemograma con diferencial y la eritrosedimentación fueron normales. Conclusiones: El exantema y la fiebre son los síntomas de mayor presencia y el estudio en orina por reacción en cadena de la polimerasa informa mayor número de pacientes positivos que en suero, según el momento del ingreso. Los complementarios de rutina son poco sugerentes de zika en los casos sospechosos(AU)

Introduction: Zika virus is considerd as an emergent virus with no previous presence in the Cuban population. Objective: To characterize clinically patients with confirmed Zika virus. Methods: Descriptive cross-sectional study conducted in Leonor Pérez Pediatric Hospital between 2016 and 2017 during the epidemics. There were analyzed 140 clinical records of patients with zika confirmed by chain reaction of polymerase in serum and urine. There were measured clinical and laboratory variables and it was calculated the assisted rate. Results: The assisted rate was 44.35 × 100 suspected cases. From the analyzed clinical records, 72.1 percent corresponded to the male sex and the average age was 10.9 ± 5.5 years. The chain reaction of polimerase was positive in a higher percentage of patients in urine than in serum: 52.1 percent and 40.7 percent, respectively and corresponding with the day when the urine sample was taken. Rash was present in 84.3 percent of the patients and fever in 70.0 percent. Pruritus, red eyes, cephalalgia, general discomfort, pain behind the eyes, odynophagia, arthralgia, anorexia and edemas were observed in less than 35.0 percent of the cases. The averages of the components of blood count with differential and the erythrocyte sedimentation were normal. Conclusions: Rash and fever are the most frequent symptoms and the study of urine by chain reaction of polimerase informs of a higher number of positive patients than in the study of serum, according to the time of admittion. The routine complementary tests are not suggestive of zika in suspected cases(AU)

Clinical characteristics of children with congenital Zika syndrome: a case series / Características clínicas de crianças com síndrome do zika congênita: uma série de casos

ABSTRACT Background: The congenital Zika syndrome involves structural brain changes, including ventriculomegaly, thin cerebral cortices, abnormal gyral pattern, cortical malformations, hypoplasia of the corpus callosum, myelination delay, subcortical diffuse calcifications, brainstem hypoplasia, and microcephaly in newborns. Objective: This study aimed to describe the clinical characteristics of children with congenital Zika syndrome; to compare the outcomes of infants infected in the first (1T, n=20) and second trimesters of pregnancy (2T, n=11); to investigate correlations between birth weight, birth and follow-up head circumference, birth gestational age, and gross motor scores. Methods: Participants were evaluated with Alberta Infant Motor Scale (AIMS) and part A of the Gross Motor Function Measure (GMFM-A). ANOVA compared head circumference, birth gestational age, birth weight, and gross motor performance of 1T and 2T. Results: The correlations were investigated by Pearson correlation coefficients. ANOVA showed differences in birth and follow-up head circumferences. Head circumference was smaller in 1T, compared to 2T. Motor performance was classified as below the fifth percentile in AIMS in all children and 1T showed lower scores in prone, sitting, and total AIMS score, compared to 2T. Children ranged from 8 to 78% on GMFM-A and there was a poorer motor performance of 1T. Nineteen children showed hypertonia, six showed normal tone and six showed hypotonia. Birth head circumference was correlated with AIMS prone postural control. Follow-up head circumference was correlated to prone, supine and total AIMS scores. Smaller head circumference at birth and follow-up denoted poorer postural control. Discussion: Children with congenital Zika syndrome showed microcephaly at birth and follow-up. Smaller head circumferences and poorer motor outcomes were observed in 1T. Infants showed poor visual and motor outcomes. Moderate positive correlations between birth and follow-up head circumference and gross motor function were found.

RESUMO Introdução: A síndrome congênita do zika envolve alterações estruturais do cérebro, incluindo ventriculomegalia, córtices finos do cérebro, padrão giral anormal, malformações corticais, hipoplasia do corpo caloso, atraso de mielinização, calcificações difusas subcorticais, hipoplasia do tronco cerebral e microcefalia em recém-nascidos. Objetivo: Este estudo teve como objetivo descrever as características clínicas de crianças com síndrome congênita do zika; comparar os resultados de bebês infectados no primeiro (1T, n=20) e no segundo trimestres da gravidez (2T, n=11); investigar correlações entre peso ao nascer, perímetro cefálico ao nascer e acompanhamento, idade gestacional ao nascer e escores motores brutos. Método: Os participantes foram avaliados com a Escala Motora Infantil de Alberta (Alberta Infant Motor Scale - AIMS) e a parte A da Medida da Função Motora Grossa (Gross Motor Function Measure - GMFM-A). A ANOVA comparou a circunferência da cabeça, a idade gestacional ao nascer, o peso ao nascer e o desempenho motor bruto de 1T e 2T. As correlações foram investigadas pelos coeficientes de correlação de Pearson. A ANOVA mostrou diferenças no perímetro cefálico ao nascimento e acompanhamento. A circunferência da cabeça foi menor no 1T, em comparação ao 2T. Resultados: O desempenho motor foi classificado como abaixo do quinto percentil na AIMS para todas as crianças e o 1T apresentou escores mais baixos na posição de bruços, sentado e no escore total da AIMS, em comparação ao 2T. As crianças variaram de 8 a 78% no GMFM-A e houve um desempenho motor pior de 1T. Dezenove crianças apresentaram hipertonia, seis apresentaram tônus normal e seis apresentaram hipotonia. A circunferência da cabeça no nascimento foi correlacionada com o controle postural em posição de bruços à AIMS. Discussão: O perímetro cefálico de acompanhamento foi correlacionado aos escores AIMS em posição de bruços, em supino e no escore total. Menor perímetro cefálico ao nascimento e acompanhamento indicaram pior controle postural. Crianças com síndrome congênita do zika apresentaram microcefalia ao nascimento e acompanhamento. Circunferências da cabeça menores e piores resultados motores foram observados no 1T. Os bebês apresentaram maus resultados visuais e motores. Foram encontradas correlações moderadas positivas entre o nascimento e a circunferência da cabeça de acompanhamento, e a função motora grossa.

Análise da soroprevalência por tese rápido e ELISA de infecção por zika vírus em unidade prisional de Mato Grosso / Seroprevalence analysis by rapid thesis and ELISA of Zika virus infection in a jail in Mato Grosso / Análisis de seroprevalencia por tesis rápida y ELISA de infección por el virus del Zika en una unidad penitenciaria en Mato Grosso

A emergência do Zika vírus no Brasil entre os anos de 2015 e 2016 com graves morbidades relacionadas, suscitou a necessidade da disponibilidade de teste diagnóstico de qualidade. Neste contexto buscou-se analisar a soroprevalência da infecção por zika em unidade prisional feminina do estado de Mato Grosso através do teste rápido (Bahiafarma) e do Ensaio Imunossorvente por Ligação Enzimática de Captura de Anticorpos para Zika. Trata-se de estudo transversal, com abordagem quantitativa pautado em dados coletados em 2018, em que se coletou sangue periférico e procedeu-se análise com duas estratégias diagnósticas o teste rápido e Ensaio Imunossorvente por Ligação Enzimática de Captura de Anticorpos para Zika. Em ambos os testes, detectou-se sororreatividade para zika, com excelentes concordâncias, ou seja, calculado o coeficiente Kappa, no qual foram obtidos os valores de 1 para IgM e 0,86 para IgG. Além dos achados laboratoriais, foram relatados fatores de risco para a infecção, decorrentes das características intrínsecas ao ambiente prisional e do modo de vida das participantes. A descrição da soroprevalência dessa arbovirose será importante para direcionar as ações de prevenção e controle a serem implementadas pela vigilância epidemiológica.(AU)

The emergence of Zika virus in Brazil between 2015 and 2016 with serious related morbidities, raised the need for the availability of quality diagnostic testing. In this context, we sought to analyze the seroprevalence of zika infection in a female prison unit in the state of Mato Grosso through the rapid test (Bahiafarma) and the Zika Antibody Capture Enzyme Immunosorbent Assay. This is a cross-sectional study with a quantitative approach based on data collected in 2018, in which peripheral blood was collected and analyzed with two diagnostic strategies: rapid test and Zika Antibody Capture Enzyme Immunosorbent Assay. In both tests, zika seroreactivity was detected, with excellent agreement, that is, the Kappa coefficient was calculated, in which the values of 1 for IgM and 0.86 for IgG were obtained. In addition to laboratory findings, risk factors for infection resulting from the intrinsic characteristics of the prison environment and the lifestyle of the participants were reported. The description of the seroprevalence of this arbovirus will be important to guide the prevention and control actions to be implemented by epidemiological surveillance.(AU)

La aparición del virus del Zika en Brasil entre 2015 y 2016 con graves enfermedades relacionadas, planteó la necesidad de contar con pruebas de diagnóstico de calidad. En este contexto, buscamos analizar la seroprevalencia de la infección por zika en una unidad penitenciaria femenina en el estado de Mato Grosso a través de la prueba rápida (Bahiafarma) y el Ensayo inmunoenzimático de captura de anticuerpos de Zika. Este es un estudio transversal con un enfoque cuantitativo basado en datos recopilados en 2018, en el que se recolectó y analizó sangre periférica con dos estrategias de diagnóstico: prueba rápida y el Ensayo inmunoenzimático de captura de anticuerpos de zika. En ambas pruebas, se detectó seroreactividad del zika, con excelente concordancia es decir, se calculó el coeficiente Kappa, en el que se obtuvieron los valores de 1 para IgM y 0.86 para IgG. Además de los hallazgos de laboratorio, se informaron los factores de riesgo de infección resultantes de las características intrínsecas del ambiente de la prisión y el estilo de vida de los participantes. La descripción de la seroprevalencia de este arbovirus será importante para guiar las acciones de prevención y control que se implementarán mediante la vigilancia epidemiológica.(AU)

Zika virus RNA excretion in sweat with concomitant detection in other body fluid specimens

We evaluated sweat, blood and urine specimens obtained from an ongoing cohort study in Brazil. Samples were collected at pre-established intervals after the initial rash presentation and tested for Zika virus (ZIKV) RNA presence by real-time reverse transcriptase polymerase chain reaction (rRT-PCR). From 254 participants with confirmed infection, ZIKV RNA was detected in the sweat of 46 individuals (18.1%). Sweat presented a median cycle threshold (Ct) of 34.74 [interquartile range (IQR) 33.44-36.04], comparable to plasma (Ct 35.96 - IQR 33.29-36.69) and higher than urine (Ct 30.78 - IQR 28.72-33.22). Concomitant detection with other specimens was observed in 33 (72%) of 46 participants who had a positive result in sweat. These findings represent an unusual and not yet investigated virus shedding through eccrine glands.

Desarrollo y validación del método de amplificación isotérmica mediada en lazo para la detección del virus Zika / Development and validation of loop-mediated isothermal amplification for the detection of the Zika virus

RESUMEN Se desarrolló un método de amplificación isotérmica mediada en lazo de transcriptasa inversa (RT-LAMP) para detectar Zika. Los primers se diseñaron basándose en la región NS5 de 64 genomas completos. Se usó reactivo LAMP liofilizado. Inicialmente, se probaron siete arbovirus diferentes y solo las muestras de Zika resultaron positivas. Además, las diluciones seriadas de una de los ARN de Zika se compararon mediante RT-LAMP y qRT-PCR, demostrando que RTLAMP es 1000 veces más sensible. También se evaluó 300 muestras de suero usando RT-LAMP y los resultados se compararon con los métodos de qRT-PCR estándar y obtuvimos un 99,3% (IC95%: 97,7 - 100,0) de sensibilidad, 100% (IC95%: 99,7 - 100,0) de especificidad, 100% (IC95%: 99,7 -100,0) de valor predictivo positivo y 99,3% (IC95%: 97,7 - 100,0) de valor predictivo negativo. En conclusión, este método brinda una alternativa de bajo costo, alto rendimiento, viabilidad y confiabilidad para el diagnóstico rápido de Zika en instalaciones de atención primaria de salud.

ABSTRACT A Reverse Transcription Loop-mediated Isothermal Amplification (RT-LAMP) method was developed to detect Zika. The primers were designed based on the NS5 region of 64 complete genomes. Lyophilized LAMP reagent was used. Initially, seven different arboviruses were tested and only Zika samples tested positive. Additionally, serial dilutions of one of Zika's RNA were compared using RT-LAMP and qRT-PCR, demonstrating that RT-LAMP is 1,000 times more sensitive. We also evaluated 300 serum samples with RT-LAMP comparing the results with standard qRT-PCR methods, and we obtained a 99.3% sensitivity, 100% specificity, 100% positive predictive value, and 99.3% negative predictive value. In conclusion, this method provides a low-cost, high-performance, viable, and reliable alternative for the rapid diagnosis of Zika in primary health-care facilities.

Zika como causa de aborto espontáneo en zonas endémicas / Zika as a cause of spontaneous abortion in endemic areas

Resumen Introducción: Aunque en la mayoría de los casos la infección por el virus del Zika (ZIKV) causa enfermedad febril sin complicaciones, en mujeres embarazadas es causa reconocida de alteraciones congénitas y muerte fetal. La microcefalia es la característica descrita con mayor frecuencia en el síndrome congénito por este virus. Caso clínico: Paciente de sexo femenino de 23 años de edad que cursaba la novena semana de gestación (SDG) por la fecha de la última menstruación y la 10.3 SDG por ultrasonido. Acudió a los servicios de salud por presentar un cuadro clínico compatible con infección por el ZIKV, la cual se confirmó por estudios de laboratorio. A las 18.6 SDG se documentó feto único sin movimientos, con datos de microcefalia, tórax con área cardiaca sin actividad, placenta corporal anterior con calcificación en el 30% e imagen probable de lago venoso versus quiste placentario. La paciente ingresó en urgencias por aborto diferido. Se indujo el trabajo de parto y se obtuvo por vía vaginal un producto masculino de 80 g, con perímetro cefálico de 9 cm. El análisis del cordón umbilical por la reacción en cadena de la polimerasa con retrotranscriptasa confirmó el diagnóstico de síndrome congénito por ZIKV. Conclusiones: Durante el embarazo debe sospecharse la infección por ZIKV para realizar un diagnóstico oportuno y ofrecer una atención integral. La pérdida del producto de la concepción en estas pacientes se ha documentado, y se ha encontrado ARN del ZIKV en las biopsias de las vellosidades coriónicas, lo que podría sugerir el aborto espontáneo de manera temprana durante la viremia.

Abstract Background: Although in most cases Zika is an uncomplicated febrile disease, in pregnant women is a recognized cause of congenital disorders. Microcephaly is the characteristic most frequently described in the congenital Zika virus syndrome, and the diagnosis requires laboratory confirmation. Case report: A 23-year-old female on the ninth week of pregnancy by date of last menstrual period and 10.3 weeks by ultrasound, attended to Health Services, presenting clinical manifestations of Zika infection, which was later confirmed by laboratory tests. In her 18.6 weeks of pregnancy, a non-mobile single fetus was documented. Additional findings were microcephaly, lack of thorax with cardiac activity, anterior corporal placenta with 30% calcification, and an image of probable venous lake versus placental cyst. She was admitted to the emergency room for late abortion and labor was induced, obtaining an 80 g male product with head circumference of 9 cm. Reverse transcription polymerase chain reaction analysis on the umbilical cord was positive for Zika virus. Conclusions: Zika infection during pregnancy must be suspected and diagnosed promptly to offer comprehensive care. The loss of conception in these patients has been documented with results of chorionic villus biopsies, finding Zika virus RNA and suggesting spontaneous abortion early during viremia.