Clinical-epidemiological features of 13 cases of melioidosis in Brazil.

The aim of this work was to catalog the clinical and ecoepidemiological characteristics of melioidosis in Brazil. The clinical-epidemiological features of melioidosis in Ceará are similar to those in other regions where the disease is endemic. These findings support the inclusion of this Brazilian state as part of the zone of endemicity for melioidosis.

Multicentre prospective study on dengue classification in four South-east Asian and three Latin American countries.

OBJECTIVE: To evaluate the existing WHO dengue classification across all age groups and a wide geographical range and to develop a revised evidence-based classification that would better reflect clinical severity. METHODS: We followed suspected dengue cases daily in seven countries across South-east Asia and Latin America and then categorised them into one of three intervention groups describing disease severity according to the overall level of medical and nursing support required. Using a pre-defined analysis plan, we explored the clinical and laboratory profiles characteristic of these intervention categories and presented the most promising options for a revised classification scheme to an independent group of WHO dengue experts for consideration. Potential warning signs were also evaluated by comparing contemporaneous data of patients who progressed to severe disease with the data of those who did not. RESULTS: A total of 2259 patients were recruited during 2006-2007 and 230 (13%) of the 1734 laboratory-confirmed patients required major intervention. Applying the existing WHO system, 47/210 (22%) of patients with shock did not fulfil all the criteria for dengue haemorrhagic fever. However, no three-tier revision adequately described the different severity groups either. Inclusion of readily discernible complications (shock/severe vascular leakage and/or severe bleeding and/or severe organ dysfunction) was necessary to devise a system that identified patients requiring major intervention with sufficient sensitivity and specificity to be practically useful. Only a small number of subjects (5%) progressed to severe disease while under observation; several warning signs were identified, but much larger studies are necessary to fully characterize features associated with disease progression. CONCLUSIONS: Based on these results, a revised classification system comprised of two entities, 'Dengue' and 'Severe Dengue', was proposed and has now been incorporated into the new WHO guidelines.

Involvement of the central nervous system in dengue fever: three serologically confirmed cases from Fortaleza, Ceara, Brazil

Neste trabalho säo descritos tres casos de dengue com manifestaçöes neurológicas incomuns durante a epidemia de dengue em Fortaleza, Estado do Ceará, em 1994. Todos os pacientes eram do sexo feminino. A paciente do primeiro caso tinha 17 anos e apresentou além da sindrome febril, sinais de comprometimento meningeo com rigidez de nuca, e sangramento genital. No segundo caso a paciente de 86 anos apresentou quadro febril, intensa dor muscular e articular, alteraçöes da consciencia, desmaio, rigidez de nuca e meningismo. A terceira, de 67 anos, teve um quadro inicial de sindrome febril, seguido de comportamento anormal, tremores de extremidades, trombocitopenia, hematocrito aumentado, leucopenia, hipotensäo arterial e choque, evoluindo para obito...