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1.
Am J Trop Med Hyg ; 74(3): 449-56, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16525106

RESUMO

Dengue, the most prevalent arthropod-borne viral disease of humans, is caused by four serotypes of dengue virus (DENV 1-4). Although all four DENV serotypes cause a range of illness, defining precisely which clinical characteristics are associated with the distinct serotypes has been elusive. A cross-sectional study was conducted on 984 and 313 hospitalized children with confirmed DENV infections during two time periods, respectively, in the same hospitals in Nicaragua: a 3-year period (1999-2001) when DENV-2 accounted for 96% of the viruses identified, and the 2003 dengue season when DENV-1 predominated (87% of identified serotypes). When the two periods were compared, more shock (OR 1.91, 95% CI 1.35-2.71) and internal hemorrhage (OR 2.05, CI 1.16-3.78) were observed in the period when DENV-2 predominated, whereas increased vascular permeability was associated to a greater degree with the DENV-1 period (OR 2.36, CI 1.80-3.09). Compared with the DENV-2 period, the DENV-1 season was associated with more hospitalized primary dengue cases (OR 3.86, CI 2.72-5.48) and more primary DENV infections with severe manifestations (OR 2.93, CI 2.00-4.28). These findings provide new data to characterize the pathogenic potential of distinct DENV serotypes in human populations.


Assuntos
Vírus da Dengue/crescimento & desenvolvimento , Dengue/classificação , Adolescente , Anticorpos Antivirais/sangue , Criança , Pré-Escolar , Estudos Transversais , Dengue/sangue , Dengue/patologia , Dengue/virologia , Feminino , Hematócrito , Hemorragia/patologia , Hemorragia/virologia , Humanos , Lactente , Masculino , Contagem de Plaquetas , Sorotipagem , Choque/patologia , Choque/virologia , Trombocitopenia/patologia , Trombocitopenia/virologia
2.
Am J Trop Med Hyg ; 73(6): 1059-62, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16354812

RESUMO

The World Health Organization (WHO) scheme for classification of dengue severity was evaluated in a three-year study of 1,671 confirmed dengue cases in three Nicaraguan hospitals. The WHO classification of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) was compared with the presence of hemorrhagic manifestations, signs of vascular permeability, marked thrombocytopenia, and shock in 114 infants, 1,211 children, and 346 adults. We found that strict application of the WHO criteria fails to detect a significant number of patients with severe manifestations of dengue, especially in adults.


Assuntos
Dengue/epidemiologia , Dengue/patologia , Guias como Assunto , Avaliação de Resultados em Cuidados de Saúde , Índice de Gravidade de Doença , Organização Mundial da Saúde , Adolescente , Adulto , Criança , Pré-Escolar , Dengue/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Nicarágua/epidemiologia , Dengue Grave/epidemiologia , Dengue Grave/etiologia , Dengue Grave/patologia
3.
Am J Trop Med Hyg ; 73(6): 1063-70, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16354813

RESUMO

To investigate age-related differences in dengue severity, 114 infants, 1,211 children, and 346 adults with laboratory-confirmed dengue virus (DEN) infections presenting to three hospitals in major urban centers in Nicaragua were recruited from 1999 to 2001. The age distribution of dengue cases and the circulating serotype (predominantly DEN2) were representative of national data. Similar results were obtained when either dengue hemorrhagic fever/dengue shock syndrome or its principal manifestations (vascular permeability, internal hemorrhage, marked thrombocytopenia, and/or shock) were analyzed in relation to age and immune status. The burden of disease and of severe dengue was found predominantly in infants 4-9 months of age and in children 5-9 years old, and secondary DEN infection was a risk factor for severity in children. Age-related differences were identified in the prevalence of specific clinical manifestations as well as in their association with a confirmed DEN diagnosis. This represents one of the few comprehensive studies to analyze characteristics of dengue in infants, children, and adults in the same population and highlights age-related differences in dengue severity.


Assuntos
Dengue/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Dengue/etiologia , Dengue/patologia , Feminino , Hospitais Urbanos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Nicarágua/epidemiologia , Prevalência , Fatores de Risco , Índice de Gravidade de Doença
4.
Emerg Infect Dis ; 9(8): 1003-6, 2003 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12967502

RESUMO

In a hospital and health center-based study in Nicaragua, fluid intake during the 24 hours before being seen by a clinician was statistically associated with decreased risk for hospitalization of dengue fever patients. Similar results were obtained for children <15 years of age and older adolescents and adults in independent analyses.


Assuntos
Vírus da Dengue/isolamento & purificação , Dengue/epidemiologia , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Idoso , Dengue/classificação , Dengue/terapia , Vírus da Dengue/classificação , Ensaio de Imunoadsorção Enzimática , Feminino , Hidratação , Humanos , Masculino , Pessoa de Meia-Idade , Nicarágua/epidemiologia , Fatores de Risco
5.
Int J Occup Environ Health ; 8(3): 212-9, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12358077

RESUMO

This study evaluated the association between acute poisoning with organophosphate pesticides (OPs) and quantitative tactile vibration thresholds. Thresholds of the dominant index fingers and big toes of 56 men hospitalized for acute poisoning with OPs were measured at hospital discharge (1-24 days after poisoning) and around seven weeks later (24-176 days after poisoning), and compared with those of controls. Thresholds of the big toes of men with severe intentional poisonings due to neuropathic OPs (metamidophos and chlorpyrifos) increased between the first and second examinations. Threshold impairment was not detected in the index finger regardless of poisoning agent or severity. The development of threshold impairment as a consequence of severe intentional poisonings with neuropathic OPs is consistent with other reports indicating that only severe OP poisonings produce sensory peripheral nerve effects.


Assuntos
Doenças dos Trabalhadores Agrícolas/fisiopatologia , Inseticidas/intoxicação , Exposição Ocupacional/efeitos adversos , Compostos Organofosforados , Controle de Pragas/métodos , Limiar Sensorial/efeitos dos fármacos , Tato/efeitos dos fármacos , Vibração , Doença Aguda , Adolescente , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Nicarágua
6.
Int J Occup Environ Health ; 8(1): 19-26, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-11843436

RESUMO

The course of organophosphate-induced delayed polyneuropathy (OPIDP) in humans has not been quantitatively measured in epidemiologic studies. This study evaluated the association of acute OP poisonings with motor neurologic impairment. Hand grip and pinch strength were evaluated among 62 Nicaraguan men hospitalized for acute OP poisoning between 1992 and 1996; 39 cattle ranchers and fishermen who had never experienced pesticide poisoning were controls. Exposure categories were moderate and severe poisonings with neuropathic and non-neuropathic OPs. Strength was measured at hospital discharge and seven weeks after poisoning. Grip and pinch strength were impaired among all OP-poisoned subjects at both examinations, more noticeably among those poisoned with OPs with suspected neuropathic effects, methamidophos and chlorpyrifos. In those with severe poisonings with neuropathic OPs, impairments were more marked among intentional than among occupational poisonings. The performances of suicidal subjects worsened at the second examination, consistent with OPIDP. Early motor impairment at the time of hospital discharge is consistent with cholinergic depolarization blockade after acute poisoning. The persistence of deficits in motor strength in all severely poisoned patients regardless of pesticide type was unexpected, and may reflect persistent cholinergic blockade or intermediate syndrome, neuropathy, or a combination of these.


Assuntos
Força da Mão , Inseticidas/intoxicação , Doença dos Neurônios Motores/induzido quimicamente , Exposição Ocupacional , Compostos Organofosforados , Adolescente , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Tentativa de Suicídio , Fatores de Tempo
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